Patient Care Process Research Articles

Professional competencies of oncology nurses: Recognizing advanced practice in nursing

ObjectiveTo identify the competency profile of advanced practice nurses involved in the care process of cancer patients. MethodsCross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. ResultsA total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. 9 (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master’s degree and 2 (6.9%) with a PhD. ConclusionsThere are nurses who carry out their activity in the oncology field of the hospital analyzed with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients' quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.

Improving Student Confidence in the Pharmacists’ Patient Care Process: A Defined Instructional Approach

Improving Student Confidence in the Pharmacists’ Patient Care Process: A Defined Instructional Approach

Examining the Role of Decision-Making Process in Patient Care

Examining the Role of Decision-Making Process in Patient Care

Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer.

Patients with pancreatic cancer who develop irreversible cancer cachexia have a life expectancy of less than 3 months. Therefore, it is extremely important to evaluate the patient's nutritional status as early as possible and to implement an appropriate nutritional intervention in order to reduce the risk of further weight loss and/or muscle loss, which affect the outcomes of cancer treatment and the correct nutritional treatment in patients with pancreatic cancer. A literature review was performed by using the PubMed and Cochrane quick search methodology. The main purpose of this review was to present the current approach to nutritional treatment in pancreatic cancer. The review included publications, most of which concerned clinical nutrition as part of the phase of treatment of patients with pancreatic cancer, nutritional and metabolic disorders in pancreatic cancer, and the period after pancreatic resection. Some of the publications concerned various nutritional interventions in patients with pancreatic cancer undergoing chemotherapy or surgical treatment (nutritional support before surgery, after surgery, or during palliative treatment). There is an unmet need for integrated nutritional therapy as a key part of the comprehensive care process for PC patients. Nutritional counseling is the first line of nutritional treatment for malnourished cancer patients, but pancreatic enzyme replacement therapy also constitutes the cornerstone of nutritional treatment for relieving symptoms of indigestion and maintaining or improving nutritional status.

Medication histories to identify medication-related problems through the pharmacists' patient care process in a simulated ambulatory care laboratory

Background and purposeAssessment of the Pharmacists' Patient Care Process (PPCP) in pharmacy curricula has been reported in a variety of contexts, but results have not described individual student performance in a controlled ambulatory care skills laboratory to purposefully identify medication-related problems (MRP) and develop plans for resolution. Educational activity and settingOne of five MRPs was embedded within standardized medication profiles to facilitate student completion of three graded ambulatory care medication history encounters in a third-year skills laboratory. Data analysis included student performance in aggregate and according to MRP type from the first to the third medication history encounter. FindingsOne hundred thirty-six students completed three medication histories for 408 encounters. Regardless of MRP, the total and subscale scores for adjusted marginal means were significantly higher in Sessions 2 and 3. Performance on MRP scenarios for drug interactions and adverse effects were significantly lower and higher, respectively. Successful collection of patient history significantly influenced marginal mean scores for respective MRPs. SummaryImprovement in student application of PPCP Steps 1 through 3 may be evident using three simulated ambulatory care medication history patient encounters toward the end of the third professional year, with potential influences by MRP type, MRP repetition, and adequate collection of patient history. Repetition with individualized grading and formative feedback are essential for skill development to identify MRPs in this setting. Confirmation of findings and extension into experiential education with higher complexity are needed to develop consistent and effective application of the PPCP to patient care.

Diseño e implementación de centros de cuidado clínico en espondiloartritis. Un modelo de atención y de enfermedad referente en patologías crónicas

IntroductionSpondyloarthritis (SpA) is a musculoskeletal disease presenting with phenotypic clinical manifestations, integrating a set of interrelated inflammatory conditions, which share immunogenetic, epidemiological, and therapeutic characteristics. Objectiveto do a reflection exercise through the experience of designing and implementing a clinical care center for spondyloarthropathies, from the administrative and clinical perspective to the implications in decision making and impact on the different indicators related to efficiencies and safety of the services included in the model. ResultsIn clinical practice, the reality of the care process in patients diagnosed with SpA represents an area of opportunity in multiple aspects. The fragmentation of clinical care and the heterogeneous flow of the patient in the care pathway, are associated with suboptimal and undesired clinical outcomes. Several aspects highlight the reality of patients with SpA in the national scenario, which -to a certain extent- could reflect what is observed in other Latin American countries. SpA represents a very significant burden for society and for individuals affected by this condition. Comprehensive assessment of the burden of disease from the perspective of the clinician and the patient is important, in order to support decisions related to treatment and comprehensive management of this condition. The improvement in health outcomes and the reduction in the cost of chronic inflammatory diseases, such as SpA, are the main advantages of implementing a care model in specialized centres integrating a multidisciplinary team. ConclusionThis is an opportunity to include the perspective of individuals affected by this condition, seeking integration between an informed patient and a highly qualified multidisciplinary care team in the comprehensive management of patients with SpA.

Health care providers' perspectives on challenges and opportunities of intercultural health care in diabetes and obesity management: a qualitative study.

Migrants often face worse health outcomes in countries of transit and destination because of challenges such as financial constraints, employment problems, lack of a network of social support, language and cultural differences, and difficulties accessing health services. As understanding how the migrant context affects patient-provider engagement is critical to the provision of contextually appropriate care, this study aimed at understanding primary health care provider perspectives on challenges and opportunities of the intercultural care process for migrant patients with diabetes and obesity. This qualitative study within a multimethod, participatory research project involved primary care providers in clinics and primary care networks in Edmonton, Alberta, between September 2019 and February 2020. We explored health care providers' approaches to diabetes and obesity management, and experiences of and challenges with intercultural care. We conducted a thematic analysis using an interpretive qualitative approach. We conducted 9 interviews and 4 focus groups and identified 3 themes: a shift from traditional weight loss-centred approaches; relationships and navigating cultural distance; and importance of and limitations in identifying and addressing root causes and barriers. Health care providers encounter considerable nonmedical challenges when supporting immigrant patients, such as navigating cultural distance and working with patients' financial constraints. The nonmedical challenges we identified can hinder the process of chronic disease management. Thus, in addition to educational programs and trainings to enhance the cultural competency of health care providers, incorporating avenues for cultural brokering in health care can provide invaluable support in patient-provider engagements to mitigate these challenges.

Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department

Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to...

Digital Health Opportunities and Risks: The Psychological Field

The digital transformation in the health sector represents an extraordinary challenge not only concerning patient care and assistance processes but also for the purpose of promoting new models capable of responding to the growing complexity of the environment and its impact on health. Psychological services are among the non-medical healthcare services heavily invested by this radical transformation. The constant increase in online psychology demand by users follows the need to carefully regulate its practice since this digital space, virtually a non-place, is the focus of large commercial interests. Being a part of the application of digital technologies to psychological performance, the aim of the paper was to emphasize clinical work, especially focused on childhood and adolescence with the need of identifying the limits and problems of digital health psychology in this group of subjects. Considering also that the massive use of digitization in healthcare also raises considerations of a bioethical nature regarding the priority of the principle of patient autonomy in the complex and articulated process of healthcare and protection. In conclusion, although TM is spread in our area in an uneven way, the representations of TM are mostly positive. However, it seems to emerge a picture in which part of some professionals still look to be too cautious and resist this new way.

The Influence Of Personal Protective Equipment (PPE)Based On The Biological And Psychological Aspects Of Nurses In The Covid-19 Pandemic

Introduction : The Covid-19 pandemic is a big challenge in the world of health, including nursing. Nurses are the main stronghold in patient care because nurses meet patients more frequently and longer than other medical personnel. The use of PPE is urgently needed in treating patients with Covid-19, the impact of using PPE cannot be avoided and can affect nurses, feelings of discomfort and poor physical condition can result in a decrease in both physical and psychological health.
 Purpose: This article review aims to determine the impact of using PPE on nurses' physical and psychological health during a pandemic.
 Method: This article was reviewed by identifying articles in the last 5 years with the theme of the effect of the use of PPE on the physiology and psychology of nurses during a pandemic with the original article inclusion criteria.
 Results: This article review collects articles from Google Scholar and ScienceDirect keywords used PPE, covid19, nurse, physical aspect, and biological aspect. The results of the identification resulted in 15 articles that met the inclusion and exclusion criteria.
 Conclusion: PPE has an impact on the physical aspects, namely respiratory disorders and fatigue. Influences on the psychological aspects are stress, depression, and anxiety. Nurses must have physical and mental health preparations to face various challenges in patient care processes and procedures during the Covid-19 pandemic.

Evaluation of the breaking points in the global care pathway of patients with atopic dermatitis

AbstractBackgroundAtopic dermatitis (AD) is a chronic pruritic skin disease with flare‐ups. All age groups can be affected. The quality of life of AD patients can be altered if their medical follow‐up is not optimal.ObjectivesThe aim of this study is to identify the breakpoints in the care pathway for patients with atopic dermatitis.MethodsWe carried out an analysis of care pathways based on responses from healthcare professionals and patients with AD using anonymized questionnaires designed by a steering committee of expert patients and health care professionals.ResultsAt the end of this survey, we collected 260 responses to the questionnaires from the patients and 57 responses from the healthcare professionals. Three break points were identified. Firstly, a large majority of patients admitted to not having enough social support and especially paramedical support. The second breaking point is patient compliance with treatment. 20% of patients discontinue their treatment, and a vast majority express a lack of information about their disease. The last point of rupture between patients and healthcare professionals is the appointment for their initial consultation; delays are underestimated or under‐reported by practitioners.ConclusionsThis study shows that some points need to be improved in the patient care process on both sides, patients, and health professional. A dialogue between the two parts should be open to focus on solutions to improve the care pathway of patients with AD.

Ethnic Disparities in ST-Segment Elevation Myocardial Infarction Outcomes and Processes of Care in Patients With and Without Standard Modifiable Cardiovascular Risk Factors: A Nationwide Cohort Study.

Trials suggest patients with ST-elevation myocardial infarction (STEMI) without 'standard modifiable cardiovascular risk factors' (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with 'SMuRFless' patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02-1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01-1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI .97-1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P < .001) or SMuRFless (87 vs 77%, P < .001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status.

Students' self-efficacy completing the pharmacist patient care process: Integrating authentic assessment into a pharmacy elective

Background: Authentic assessments can be used to accurately measure students’ ability to perform tasks reflective of practising pharmacist responsibilities. Objective: To evaluate the impact of an authentic assessment on student self-efficacy in completing the Pharmacists Patient Care Process (PPCP) in an elective course. Methods: An authentic assessment simulated a direct patient care visit in an ambulatory care setting. For the assessment, students completed four steps of the PPCP, followed by a survey to evaluate their perceived self-efficacy in completing the activity. Results: After the activity, 90% or more students felt more confident in knowing what information to collect, conducting a patient interview, and counselling a patient. General themes from free response questions confirmed student confidence and knowledge. Conclusion: Creating and implementing an authentic assessment allowed for students to demonstrate improved self-efficacy while conducting the PPCP in a setting that closely resembled a real-life practice environment.

The first decade of the DGOU's cartilage register-insights for clinical practice

Registry data provide valuable epidemiological insights that help to further improve process and outcome quality in patient care. The German Cartilage Registry (KnorpelRegister DGOU) was established in 2013 as an instrument for quality assurance after surgical cartilage regenerative procedures on hip, knee and ankle joints. Participation in the German Cartilage Registry is optional for hospitals and practices. Currently, more than 160institutions in Germany, Austria and Switzerland participate in the data collection. The implementation of PROMs ("patient related outcome measurement"), as well as the recording of surgery-related influencing factors, enable adifferentiated scientific analysis and represent akey quality feature of the registry. Initial analyses of the registry data have already provided clinically relevant findings for immediate patient care. For example, patients who underwent focal cartilage therapy prior to ACT show aclinically relevant, significantly worse outcome than patients who underwent primary ACT. First conclusions could also be drawn regarding the relevance of concomitant cartilage therapy. For example, in patients with focal cartilage damage of the medial knee joint compartment, registry data indicate that leg axis correction is indicated even in cases of mild deviation of the mechanical leg axis. The data and findings obtained from the Cartilage Registry represent an important aspect of clinical care research and serve as acomplement to well-designed, clinically prospective cohort studies, RCTs, and meta-analyses.

Creation and execution of an effective critical care pharmacist collaborative in an academic health system

AbstractHospital systems continue to face significant pressure to mitigate medication costs, which may be achieved by effective pharmacy collaboration between medical centers. The purpose of this narrative is to discuss the essential elements, methods, obstacles, and solutions that were encountered in the formation and function of a successful multicenter pharmacy collaborative. The objective is to share the tools and examples that illustrate the framework and mechanics employed by a collaborative to execute initiatives that improved patient care and institutional processes. In 2018, five academic medical centers (AMCs) formed a critical care pharmacy collaborative team (PCT). The group's sustainable leadership structure allowed for equal voicing while avoiding individual burnout. Focused monthly working meetings allowed for comparison of each AMC's best practices to identify unexplored practice gaps and project planning. System goals with standardized metrics were set and parallel institutional approaches were implemented. Pooling use experience from five AMCs allowed for a larger sample size for data evaluation to assist in management of high impact medications. Additional benefits of group collaboration extended to research opportunities and incorporation of pharmacy learners for practice‐based learning. During this journey, barriers were uncovered including inconsistent access to a centralized secure platform for information sharing, data collection and analysis, overreliance of responsibilities on few individuals, and unpredictable dedicated project time for team leads and members. Overall, pharmacist led stewardship projects across five AMCs were leveraged to advance patient care through increased clinical guideline adherence, operational efficiency, and medication cost savings.

Hospital Management System for Enhancing Patient Care and Executive Process

Abstract: Our hospital management system in our project includes registering patients, storing information in the system and scheduling appointments with doctors. Our software has the ability to assign a unique ID to each patient and automatically store the details of each patient and staff. Users can search patient details using availability and doctor name. The hospital administration can be accessed with a username and password. It can be accessed by administrator or host. It can only add information to the database. Information is easily available. The interface is user friendly. Data is well protected for personal use and speed up data processing. There are mainly two modules. One at the Management level and the other for patient users and doctors. the program that validates the software for access. Administrative duties include managing physician information and patient information. To achieve this goal, a database has been created, one for patients and another for doctors that can be accessed by the administrator. Complaints filed by users will be answered by the authorities. The patient module includes appointments, prescription checks. Users can also pay doctor bills online.

Prehospital characteristics that identify major trauma patients: A hybrid systematic review protocol

Background: International evidence has consistently demonstrated significant improvements both in the trauma care process and outcomes for patients through re-configuring care services from that which is fragmented to integrated trauma networks. A backbone of any trauma network is a trauma triage tool. This is necessary to support paramedic staff in identifying major trauma patients based on prehospital characteristics. However, there is no consensus on an optimal triage tool and with that, no consensus on the minimum criteria for prehospital identification of major trauma. Objective: Examine the prehospital characteristics applied in the international literature to identify major trauma patients. Methods: To ensure the systematic review is both as comprehensive and complete as possible, we will apply a hybrid overview of reviews approach in accordance with best practice guidelines. Searches will be conducted in Pubmed (Ovid MEDLINE), Embase, Cochrane Library of Systematic Reviews and Cochrane Central Register of Clinical Trials. We will search for papers that analyse prehospital characteristics applied in trauma triage tools that identify major trauma patients. These papers will be all systematic reviews in the area, not limited by year of publication, supplemented with an updated search of original papers from November 2019. Duplication screening of all articles will be conducted by two reviewers and a third reviewer to arbitrate disputes. Data will be extracted using a pre-defined data extraction form, and quality appraised by the Newcastle Ottawa Quality Assessment form. Conclusions: An exhaustive search for both systematic reviews and original papers will identify the range of tools developed in the international literature and, importantly, the prehospital characteristics that have been applied to identify major trauma patients. The findings of this review will inform the development of a national clinical prediction rule for triage of major trauma patients.

C87 IMPACT OF THE COVID 19 PANDEMIC ON ADHERENCE TO PATIENT CARE PATHWAYS AFTER ACUTE CORONARY SYNDROME WITH ST ELEVATION (STEMI) IN FRIULI–VENEZIA–GIULIA (FVG). REGIONAL DIAGNOSTIC THERAPEUTIC PLANS INDICATORS

Abstract Background In recent years, the treatment of STEMI has made significant progress which has led to an increase in survival and age of patients who have become chronic heart disease. Management is a major problem especially in the post–acute and chronic phases, previously considered stable. Post–hospital morbidity and mortality are increased particularly in patients with high residual risk. Methods The purpose of this work is to evaluate adherence to patient care pathways after STEMI in FVG from 2018 to 2021. This evaluation must take into account the restrictive measures adopted since March 2020 to contain the COVID 19 pandemic. The data was collected by the Regional Health Agency (ARCS) thanks to the launch of the Heart Network and the regional Diagnostic Therapeutic Plans (PDTA). The indicators of care pathways were: cholesterol–lowering prescription at 30 days; antiplatelet prescription after 30 days; beta–blocker prescription after 30 days; cardiological visit 2 months after discharge; persistence of statin therapy 1 year after discharge; LDL dosage 1 year after discharge; target LDL 1 year after discharge; nursing counseling 1 year after discharge. Results Patients with STEMI in FVG in 2018 were 830, in 2019 were 834, in 2020 were 772 and in 2021 were 782. The populations do not differ significantly in terms of age and gender (with a predominance of males). Observing the data on the management of patients in the post–acute phase there are no significant differences between the populations. However, if we analyze the data indicative of the management of patients in the chronic phase, the results differ in the populations. The persistence of statin therapy at 1 year is 82.8% in 2018 and it is 80.4% in 2019 while it is 69.7% in 2020 and 62.2% in 2021. Nursing counseling at 1 year is 60.8% in 2018, 62.5% in2019 while it is 37% in 2020 and 51.9% in 2021. Conclusions The COVID 19 pandemic has impacted the post–STEMI patient care process in FVG not so much in the post–acute phase but in the chronic phase. According to international guidelines, Cardiology Rehabilitation (CR) is strongly recommended in STEMI. No treatment in heart disease has stronger scientific evidence or a significantly greater impact on survival. Despite this, the CR facilities in FVG have not been strengthened in recent years, on the contrary they have suffered more significantly from the COVID–related restrictions and the depletion of resources.

Association of Time of Day with Delays in Antimicrobial Initiation among Ward Patients with Hospital-Onset Sepsis.

Rationale: Although the mainstay of sepsis treatment is timely initiation of broad-spectrum antimicrobials, treatment delays are common, especially among patients who develop hospital-onset sepsis. The time of day has been associated with suboptimal clinical care in several contexts, but its association with treatment initiation among patients with hospital-onset sepsis is unknown. Objectives: Assess the association of time of day with antimicrobial initiation among ward patients with hospital-onset sepsis. Methods: This retrospective cohort study included ward patients who developed hospital-onset sepsis while admitted to five acute care hospitals in a single health system from July 2017 through December 2019. Hospital-onset sepsis was defined by the Centers for Disease Control and Prevention Adult Sepsis Event criteria. We estimated the association between the hour of day and antimicrobial initiation among patients with hospital-onset sepsis using a discrete-time time-to-event model, accounting for time elapsed from sepsis onset. In a secondary analysis, we fit a quantile regression model to estimate the association between the hour of day of sepsis onset and time to antimicrobial initiation. Results: Among 1,672 patients with hospital-onset sepsis, the probability of antimicrobial initiation at any given hour varied nearly fivefold throughout the day, ranging from 3.0% (95% confidence interval [CI], 1.8-4.1%) at 7 a.m. to 13.9% (95% CI, 11.3-16.5%) at 6 p.m., with nadirs at 7 a.m. and 7 p.m. and progressive decline throughout the night shift (13.4% [95% CI, 10.7-16.0%] at 9 p.m. to 3.2% [95% CI, 2.0-4.0] at 6 a.m.). The standardized predicted median time to antimicrobial initiation was 3.2 hours (interquartile range [IQR], 2.5-3.8 h) for sepsis onset during the day shift (7 a.m.-7 p.m.) and 12.9 hours (IQR, 10.9-14.9 h) during the night shift (7 p.m.-7 a.m.). Conclusions: The probability of antimicrobial initiation among patients with new hospital-onset sepsis declined at shift changes and overnight. Time to antimicrobial initiation for patients with sepsis onset overnight was four times longer than for patients with onset during the day. These findings indicate that time of day is associated with important care processes for ward patients with hospital-onset sepsis. Future work should validate these findings in other settings and elucidate underlying mechanisms to inform quality-enhancing interventions.

Patient safety in home health care: a grounded theory study

BackgroundThe home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care.DesignThe aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015.MethodIn total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015.ResultsThe results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care.ConclusionThe results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.