Positive Patient Care Outcomes Research Articles

Impact of a pharmacy technician on an interprofessional antithrombotic stewardship program at an academic medical center.

The need for monitoring and standardization of anticoagulation management has garnered the attention of national organizations, driving the implementation of antithrombotic stewardship programs (ASPs). Established ASPs have highlighted interdisciplinary collaboration between physicians, nurses, and pharmacists and demonstrated financial benefits and positive patient care outcomes. While pharmacy technicians are key members of the pharmacy profession, they are rarely utilized to expand clinical programs. The aim of this report is to describe the impact of adding a pharmacy technician to an ASP at an academic medical center. The departments of pharmacy and quality at West Virginia University Hospitals (WVUH) developed a business plan and financially justified an ASP. The ASP was implemented in January 2022 and consisted of 2 full-time clinical pharmacist specialists, 1 full-time clinical pharmacy technician, 2 full-time clinical nurse specialists, and 1 part-time physician medical director. The clinical pharmacy technician's primary role was to review patients' sequential compression device (SCD) compliance and newly started oral anticoagulants prior to discharge. The clinical nurse specialists educated patients newly started on oral anticoagulants within 24 hours of discharge and triaged any postdischarge medication access issues. The medical director provided high-level program oversight and acted as a clinical consultant on complex patient cases. In the first 6 months after the program's implementation, the clinical pharmacy technician made 174 recommendations to the clinical pharmacist specialists regarding discharge transitions of care and assessed SCD compliance in 246 patients. Of the 246 patients assessed, 217 patients (88%) were deemed to be noncompliant. The pharmacy department at WVUH successfully justified and implemented an interprofessional ASP at an academic medical center, which is the first ASP to date to incorporate a clinical pharmacy technician.

Changes in Medical Students’ Empathy Level in Different Academic Years: A Trend Analysis

Empathy is an essential attribute that enables physicians to comprehend the condition and emotions of their patients, facilitating accurate responses. Consequently, empathy has been linked to improved diagnoses and enhanced clinical outcomes. This study aimed to assess the changing patterns of empathy levels among medical students during their academic tenure in medical school. A descriptive study was conducted using convenience sampling, involving 361 medical students in Ahvaz, Iran, between September and December 2021. Empathy levels were assessed using the Persian adaptation of the Jefferson Scale of Empathy (student version) (JSE-S). Statistical analyses were conducted using the t-test and variance analysis (ANOVA). Based on the empathy scale (ranging from 20 to 140), the mean empathy score among medical students was found to be 106.42±14.8, exhibiting variations based on study year, gender, and grade point average (GPA) (p < 0.01). Notably, a significant decline in empathy scores was observed in final-year students compared to their counterparts in the first year (113.39 vs. 97.05; p < 0.001). Female students and those with higher GPAs demonstrated a higher level of empathy (p < 0.001). The results of the present study revealed that medical students in Iran exhibit a moderate level of empathy compared to findings from local studies. Furthermore, the findings suggest a decline in empathy levels as students progress through their years in medical school. Based on these findings, it is strongly recommended to integrate empathy training into the medical curriculum. Such an approach would enhance student learning and contribute to positive patient care outcomes.

Measuring Empathy among Dental Students and Interns: A Cross-Sectional Study from Dammam, Saudi Arabia.

Objective To evaluate empathy and its related factors among undergraduate dental students and interns enrolled in a public dental college in Dammam, Saudi Arabia. Materials and Methods This cross-sectional study used the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version to determine empathy in 362 dental students and interns in Dammam, Saudi Arabia. The JSE-HPS is a 20-item 7-point Likert scale questionnaire, and its score ranges from 20 to 140 with high values indicating increased empathy. Influences of age, gender, class year, previous year's grade point average (GPA), educational attainment of parents, and monthly family income on empathy were evaluated. Results Of 501 enrolled students and interns, 362 returned completed questionnaires, and the response rate of the study was 72%. The sample's empathy score (JSPE-HPS scale) ranged from 70 to 129 with a mean of 96.75 (±13.76). Most participants believed that empathy is important for effective communication with patients (96.1%) and can improve the provider-patient relationship (95.6%). Females demonstrated a significantly higher mean empathy score (99.98 ± 14.01) than males (92.72 ± 12.35) (P < 0.001). Similarly, the participants with high GPA (98.06 ± 13.69) had significantly greater mean empathy scores than those with low GPA (94.84 ± 13.68) (P=0.029). The mean empathy score increased significantly from junior students (3rd and 4th year students) to senior students (5th and 6th year students) and interns (P=0.008). Multiple linear regression analysis showed that class year (B = 2.03, P=0.006) and GPA (B = 8.67, P=0.003) were significant factors associated with empathy. Conclusions Empathy is important for effective patient communication and improved provider-patient relationship. Female gender, high GPA, and class years were associated with empathy. Empathy should be integrated into dental curricula for effective student learning and positive patient care outcomes.

Deterrents in Taking up Nursing Leadership Positions in Kenya: A Qualitative Approach

Leadership is a highly sought-after commodity and equally valued. However, the question of what makes good leaders continue to linger in most peoples' minds. Subsequently, to have a sustainable workforce in nursing, it is critical to have effective nursing leadership to address the ever-growing health care system challenges of which when resolved culminates to positive patient care outcomes. A job title does not make one a leader. For a long time, to qualify to be a nursing leader was dependent on the number of years worked. Promotion was based on the nurses' experience and the number of years worked. With time, young, learned and experienced nurses have been declining to take up senior leadership positions. Thus, the deterrents to taking up higher leadership position were explored from seven nurses in leadership positions in a private city hospital. A qualitative study was done adopting the phenomenological approach to explore the registered nurses' experiences while in leadership positions. Purposeful sampling was used. Datawas obtained through in-depth interviews. Data analysis was done usingqualitative data analysis software:f4analyse. Five themes emerge which included: lack of work life balance, too many responsibilities, inexperience in people management especially the millennials, perception of micromanagement by the senior nurses,incentives not commensurate to their responsibilities. A conclusion was drawn with recommendations on implementation of policy on work life balance, developing the nurses on people management and delegation strategies.Furthermore, mentorship programs in leadership and coaching in with a well aligned succession plan would add value. To commensurate the remuneration with the responsibilities would require assessment of the external environment, perform market surveys to gain competitive advantage, attract and retain talents.

Improving nurses’ knowledge and skills regarding tocolytics for inhibiting preterm labor

Background: Approximately 10% of all pregnant women who experience an episode of threatened preterm labor requiring hospital admission and Tocolytic therapy may be considered for them. Nursing care is the main critical component of this therapy. Nurses’ Knowledge deficit and poor practical skills regarding tocolytics and its administration, care, surely, will interfere with their ability to achieve consistent and positive patient care outcomes. Aim: The aim is to assess the impact of an instructional program on knowledge and practices of maternity nurses regarding pregnant women with tocolytics administration for inhibiting preterm labor. Methods: A quasi-experimental design was used with all nurses (n = 30) working in the inpatient of obstetrics and gynecology department in all general hospitals in Port Said city. Tools: Three tools were used; structured interview questionnaire, pre/post-test knowledge assessment sheet and an observation checklist. Results: The mean age of the participant nurses is 30.6 ± 10.3. The majority (86.6%) of them had nursing secondary school. All nurses archived better scoring in both knowledge and skills after implementing the program than before it. A significant difference between pre and post-test was observed ( p < .01). Conclusions: There is a progression of satisfactory score and regression of unsatisfactory one. The knowledge and practical scoring in the post-test are better than pre-test. This is mirrored the effect of the program. Recommendations: Continuing educational programs should be developed to teach and train nurses about the care of preterm, a complete assessment of maternal history, accurate examination of preterm labor and knowledge of tocolytics drugs.

Self-Healing and Self-Care for Nurses

The potential effects of self-care techniques to increase nurses’ effectiveness and influence positive patient care outcomes have often been underestimated. Today, nurses experience increased stress as a result of more work hours and greater patient loads. Research studies demonstrate the value to an organization and to individuals of educating nurses about self-care. Studies also show that how being aware of individual reaction patterns is vital to learning more effective coping mechanisms. In this article, we discuss the aspects of body, mind, emotions, and spirit as they relate to self-care; present self-care change techniques; and offer some practical self-care exercises. Most self-care skills can be learned and implemented in a short period of time. Nurses are encouraged to experiment with the various techniques to determine the most effective ones for them.

Comparative Evaluation of Pharmacy Patient Safety Culture in all Levels of Health Care Delivery in Delta State, Nigeria

In health care, there is a move towards a patient safety culture as a means of ensuring sustainable positive patient care outcomes. This study evaluated the safety cultures in the health institutions in Delta State, Nigeria. An adapted form of the Agency for Healthcare Research and Quality Questionnaire on Pharmacy Safety was administered to 118 pharmacy personnel in 10 hospitals spread across the 3 senatorial districts. Data was analyzed with SPSS.20. The number of pharmacists was inadequate; pharmacy organization at the secondary and tertiary levels was better than the primary level; At all three levels, the safety cultures of Staff Training and Skills, Teamwork, Communication Openness, and Patient Counseling were generally positively rated. Highly significant differences existed in the safety culture of documenting mistakes in the pharmacy. There were significant differences in most culture composites between the three levels of care. The general trend was Tertiary&gt;Secondary&gt;Primary in positivity. On the overall Rating of Patient Safety, all levels were rated Very Good / Excellent. However, there were isolated lapses in safety culture composites requiring attention; pharmacy managers, in particular, are therefore enjoined to re-evaluate the safety cultures in their domain to identify areas of systemic failure.

Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel.

Historically, health care has primarily focused on physician, nurse, and allied healthcare provider triads. Using a phenomenological approach, this study explores the potential for hospital-based interdisciplinary care provided by physicians, nurses, and unlicensed assistive personnel (UAPs). This phenomenological study used a purposive nonprobability, criterion-based, convenience sample from a metropolitan hospital. Malhotra's (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. In an orchestra, each member sees and hears the musical score from a different vantage point or perspective and has a different stock of knowledge or talent; however, members work together to produce a cohesive performance. Like the orchestra, individual talents and perspectives of physicians, nurses, and UAPs can be collaboratively blended to create a symphony: enhanced patient-centered care. Qualitative semistructured face-to-face, individual interviews were carefully transcribed and coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes. The study suggests that most of the time physicians, nurses, and UAPs operate as separate healthcare providers who barely speak to each other. Physicians see themselves as the primary patient care decision makers. Many physicians acknowledge the importance of nurses' knowledge and expertise. On the other hand, the study indicates a hierarchical, subservient relationship among nurses and UAPs. Physicians and nurses tend to work together or consult each other at times, but UAPs are rarely included in any type of meaningful patient discussion. Since physicians, nurses, and UAPs each provide portions of patient care, coordination of the various treatments and interventions provided is critical to prevent errors and fragmentation of care. Tensions, misunderstandings, and conflicts caused by differences of opinions and interests can interfere with effective interdisciplinary communications and collaboration. Improving patient safety in the hospital requires addressing the current hierarchical professional structure inherent in healthcare delivery. A hospital patient care model based on the conductorless orchestra model would mitigate hierarchy; recognize physician, nurse, and UAP contributions to care; promote improved communication and collaboration; and enhance patient safety. Study results provide additional information supporting interdisciplinary communication and collaboration education and training among physicians, nurses, and UAPs to support positive patient care outcomes.

Perception of Patients and Other Health Care Professionals about Nurses at the University College Hospital, Ibadan, Oyo State, Nigeria

Objective: To explore the perception of patients and other health care professionals about the attitude and behavior of nurses working at the University College Hospital Ibadan Oyo State. Background: Observation has shown that despite the efforts nurses put into carrying out their duties, the acknowledgement of a job well done from co-professionals and patients still leaves much to be desired. Could this be due to impressions formed about nurses? Hence, this study attempts to explore the perception of patients and other health care professionals about nurses. Methods: Two hundred (200) consented respondents were randomly selected for this study. This consists of 165 patients and 35 doctors representing other health care professionals. Data were collected through a pretested questionnaire. Analysis was done by using SPSS version 16.0. Result: Results showed that 68% of patients and 58% of doctors perceived that nurses were competent. About 75% of patients and 54% of doctors agreed that the nurses had adequate skills. Patients (70%) and doctors (49%) agreed that the nurses had a positive attitude towards work. About 74% of patients and 59% of doctors agreed to the fact that the nurses maintained a professional demeanor. Findings also showed that patients rated the nurses higher than the doctors did. A significant difference was found between the perception of patients and doctors about the communication skills of nurses (t = 2.423; df = 198; p = 0.016). Conclusion: The study shows relative satisfaction with the quality of nurse’s work, perceptions of people about their attitudes and behaviors. Nurses could improve on how they relate with other health care providers to achieve positive patient care outcomes.

Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration

Nurse practitioners (NPs) and physicians have worked together to manage patients since the inception of the NP role in the 1960s. 1 Because the underserved and rural areas lacked primary and specialty care physicians, the NP role eventually evolved to one of a collaborating midlevel provider. 2 The integrated use of NPs and physicians together has positively affected the health care system, yet barriers to effective collaboration continue to exist, and this may lead to a reduced level of quality health care for patients. The barriers to effective collaboration between NPs and physicians are important to consider because the main goals of any NP–physician collaborative team are positive patient care outcomes.

Kim Richards, RN

Kim Richards, RN

Skin Care Resource Teams: Successful Strategies to Implement Evidence-Based Practice

Quality, cost, and patient access are critical to a home health care agency’s success in a competitive market. Creating a learning environment is key to both staff satisfaction and positive patient care outcomes. Preventing adverse events and providing evidence-based care management for high-volume populations are key to an agency’s reputation for quality, cost-efficient care. This article describes the implementation of evidence-based guidelines for pressure ulcer prevention and wound care utilizing the continuous quality improvement process in performance improvement (PI) via Skin Care Resource Team (SCRT) implementation. Factors addressed are clinical quality, cost, staff motivation, productivity, and documentation burden. Effective and efficient strategies described in PI are SCRT support and rollout and integration of consistent appropriate wound, ostomy, and continence nurse consults via telehealth. The importance of linking evidence-based practice with the agency’s vision, goals, resources, and employee incentives is discussed.

Nurse Staffing and Patient Perceptions of Nursing Care

OBJECTIVE To examine the relationship between nurse staffing and patient perceptions of nursing care in a convenience sample of 40 California hospitals. Growing concern about the adequacy of nurse staffing has led to an increased emphasis on research exploring the relationships between nurse staffing and patient outcomes. Patient satisfaction with nursing care is one of the 21 indicators identified by the American Nurses Association as having a strong "theoretical link to the availability and quality of professional nursing services in hospital settings." This prospective study examined the relationship between nurse staffing and patient perceptions of nursing care in multiple hospitals using common definitions of both nurse staffing and patient perceptions of care. Nurse staffing (structural variables) and patient perceptions of nursing care (outcome variables) from hospitals participating in both the ongoing California Nursing Outcomes Coalition statewide database project and the statewide Patients' Evaluation of Performance in California project, with data available on both measures for the same time periods, were examined. Analytic methods included both descriptive and inferential statistics. Hospitals with wide ranges of staffing levels showed similar results in patient perceptions of nursing care. Regression analysis revealed a statistically significant relationship between nursing hours per patient day, and 1 of the 6 dimensions of care measured ("respect for patient's values, preferences, and expressed needs"). Nurse staffing alone showed a significant but weak relationship to patient perceptions of their care, indicating that staffing is likely only one of several relevant variables influencing patient perceptions of their nursing care. This research contributes data to the body of knowledge regarding nurse staffing. It is essential that nurse executives integrate results from this and other studies in developing strategic and tactical staffing plans that yield positive patient care outcomes.

Mandatory continuing education: past, present, and future trends and issues.

Mandatory continuing education (CE) for nurses continues to be a viable means by which nurses can remain competent in the face of ever-increasing knowledge and technology in the health care setting. A multiplicity of CE providers, offering a variety of teaching approaches, exists to ensure nurses remain competent and advance in their fields of practice. Presently, more research must be conducted to measure the effectiveness of CE programs on patient care outcomes. Scholarly investigation may assist in justifying mandatory CE for nurses if positive patient care outcomes can be identified. Several states are regulating professional nursing practitioners by requiring CE. Although some states have not endorsed mandatory CE for nurses, it is likely that more state boards of nursing will continue the slow but steady trend of requiring CE for relicensure--especially if research establishes positive patient care outcomes.

Magnet Program Designates Exceptional Nursing Services

he health care restructuring that has predominated the last decade-resulting in fewer nurses at the bedside and an epidemic of unlicensed personnel performing nursing duties-has caused nurses to become increasingly alarmed by threats to patient care. Nurses and nursing organizations, such as the ANA and the state nurses associations, have launched innovative research and programs to measure the value of nursing care to patient outcomes. One such endeavor is the Magnet Nursing Services Recognition Program, a systematic approach to ensuring positive patient care outcomes. It's administered by the American Nurses Credentialing Center (ANCC), an affiliate organization of the ANA. The magnet program recognizes those health care facilities, initially hospitals, that have fostered an environment that attracts and retains

Pet Project: The Use of Pet Facilitated Therapy Among the Chronically Mentally III

1. The effects of animal companions on people can be of therapeutic benefit. Using pet facilitated therapy with the chronically mentally ill as a treatment modality offers great potential for positive patient care outcomes. 2. Initiating a pet facilitated therapy program involves establishing policy and procedures regarding animals at the facility. The personality and animal experiences of the patient must be taken into consideration for pet selection. 3. Evaluate the effectiveness of the pet facilitated therapy program. Assess your patient care outcomes to design further interventions.

Case Management in Long-Term Care: New Directions for Professional Nursing

Case management can be a highly successful model to deal with issues of cost effectiveness, accountability, and quality care. Continuity of care is a guaranteed benefit of the case management model. Case management is a centralized or structured system whose standard is not set by those performing less effectively. Case management offers autonomy, empowerment, and positive patient care outcomes. These are magnet issues in the retention of staff nurses. The case management method of primary nursing allows for a reduction in the need for professional nurse staff.

Improving patient-oriented pharmacy services: What the director can do

How pharmacy directors can further the development of patient-oriented services is described. A philosophy of responsibility for patient outcomes instead of for specific functions is necessary for achieving pharmacy's full potential. Overall, pharmacy practice today does not reflect this sense of responsibility for drug-use control. Management that encourages greater accountability; a mission statement and goals; specific definitions of performance criteria; evaluation of services in terms of patient-care outcomes; and increased interaction with physicians, nurses, and hospital administrators are needed. A director can guide pharmacists in a recommitment to professional services that will result in positive patient-care outcomes.