Nursing Resources Research Articles

Unsafe by design: Infusion task reallocation and safety perceptions in U.S. hospitals.

Research suggests that changes in nurse roles can compromise perceived organizational safety. However, over the past 15 years, many infusion tasks have been reallocated from specialty nurse infusion teams to individual generalist nurses-a process we call infusion task reallocation . These changes purportedly benefit employees by allowing care providers to practice at the "top of their license." However, job demands-resources theory suggests that changing core task arrangements can either enrich or merely enlarge jobs depending on their effects on demands and resources, with corresponding consequences for performance (e.g., safety). There is relatively little research directly exploring these effects and their mechanisms. This study examines the relationship between infusion task reallocation and perceptions of organizational safety. We also explore the extent to which this relationship may be mediated by infusion-related resources and psychological safety. Data were collected through a survey of 623 nurses from 580 U.S. hospitals. The relationship between infusion task reallocation and perceptions of organizational safety, as well as the potential mediating roles of infusion-related resources and psychological safety, was examined using structural equation modeling. Infusion task reallocation was negatively associated with respondents' perceptions of organizational safety, with nurses working in organizations without an infusion team indicating lower perceptions of organizational safety than nurses working in organizations with an infusion team. This relationship was mediated by nurse perceptions of psychological safety within the organization, but not by infusion-related resources, suggesting that task reallocation is associated with lower perceived organizational safety because nurses feel less psychologically safe rather than because of perceived technical constraints. The results indicate that, although infusion task reallocation may be a cost-reducing approach to managing clinical responsibilities, it enlarges rather than enriches the job through higher demands and fewer resources for nurses and, in turn, lower perceived organizational safety.

Escaping delirium: Designing an escape room active learning experience for geriatric resource nurses

Use of a delirium escape room is an effective teaching modality that has demonstrated the application of didactic knowledge into clinical practice. Positive comments were shared by all participating nurses. In addition, this learning method was found to be effective for experienced as well as newly licensed nurses. This team building activity evolved into discussions about real life patients who experienced delirium and each group was able to connect the contributing factors with their patients. Communication, coordination, and collaboration were key components as to what lead to a successful escape for all in the end. Participant's evaluations revealed positive feedback indicating appreciation for this hands-on learning activity and “making it an enjoyable and memorable experience.”

Debunking the Myths of PACU Nursing Documentation

<h3>Background Information</h3> Weekly auditing of PACU documentation revealed inconsistencies in documentation practices among Post Anesthesia Care Unit (PACU) nurses. The individual preferences in documentation caused difficulty in retrieving data during chart review and auditing. Opportunities for standardizing documentation of nursing assessment, nursing care plan, medication administration and vital signs were identified in all PACU areas. The department identified the need to provide education on documentation accuracy, while regularly monitoring and evaluating documentation compliance. A decision was made to formulate a committee to standardize the auditing process, in order to sustain the compliance benchmark. <h3>Objectives of Project</h3> The goal of this project was to improve overall PACU documentation compliance by June 2021. The focus was to increase documentation compliance by 10% in the identified categories. The overall aim was to achieve documentation compliance of 90% in all PACU areas and have long-term sustainability. <h3>Process of Implementation</h3> •A PACU documentation committee was formed using Informatics Resource Nurses from inpatient, transitional, outpatient and out of OR PACU. The selection process involved self-nomination and leadership recommendation. •The documentation committee worked with the leadership team to develop unit-based reeducation and skills check-off to standardize documentation practices in all PACU areas. •A focused chart audit was created, and committee members conducted at least one audit per RN per month in all PACU areas. •A Peer-to-Peer Feedback Form was developed to provide real-time feedback and education to staff. •Chart Audit results were discussed in staff meetings with highlighted examples. <h3>Statement of Successful Practice</h3> •Data retrieved over the last 12 months showed significant improvement in standardizing PACU documentation and sustaining the documentation compliance above 90% in all areas. •Reeducation and skills check off helped standardize the practice and improved staff efficiency in documentation. •Review of the audit tool, guidelines for auditing and monthly meetings enhanced committee members' engagement and satisfaction. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Streamlining documentation expectations can improve documentation practices and sustain compliance. Some best practices include: •Training new nurses during orientation with auditors to show documentation expectations. •Develop a checklist for Nurses to ensure complete documentation and use as a resource at bedside. •Reward best practice by recognizing 100% compliance in monthly audits.

Nurse Led Collaboration and Innovation: Creating Standardized Care for Same Day Joint Arthroplasty Patients

<h3>Background Information</h3> As a Magnet designated hospital, BWFH strives to achieve excellent patient outcomes. Our dedication to provide innovative, high-quality care for patients in a busy 171-bed community teaching hospital in Boston, MA has led to the development of a successful same day joint (SDJ) program. <h3>Objectives of Project</h3> To implement strategies that facilitate the safe discharge of patients undergoing SDJ replacement surgery. <h3>Process of Implementation</h3> After successfully launching a SDJ replacement program, it was identified that nurses needed education and resources to support safe discharge home for this patient population. Identification and education of dedicated resource nurses •Development of SDJ Resource binder that includes tip sheets and checklists opre-discharge medications, hydration and nourishment guidelines, spinal anesthesia recovery protocols, pre-discharge required consultations (PT and Care Continuum Management), and home discharge instructions. <h3>Statement of Successful Practice</h3> Since April 2019, >600 patients have been discharged home the same day as their joint replacement surgery resulting in a reduced hospital length of stay compared with traditional practice. With the identification of dedicated resource nurses and the implementation of a SDJ resource binder, nurses have been able to provide high quality, standardized care. In addition, nurses have been able to identify deviations from the SDJ care pathway that might impede a successful discharge home. Nurses have reported a decrease in anxiety when caring for this population since the addition of these resources. Providers from the orthopedic teams have reported receiving fewer phone calls to clarify post-op orders and instructions. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses are collaborative and innovative in designing systems that allow for a successful SDJ program. Standardizing post-op care and having resources such as informational binders and PACU nurse champions play an important role in the safe care and discharge of SDJ patients.

Patient participation in critical care research, service design, and care delivery

Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay).This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group.The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307–166,690] for the low-cost nursing group and 214,032€ [198,094–230,058] for the high-cost group.In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69–0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72–0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42–0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97–1.51, p > 0.05).This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit..

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

IntroductionHospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay). MethodologyThis was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group. ResultsThe rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307–166,690] for the low-cost nursing group and 214,032€ [198,094–230,058] for the high-cost group.In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69–0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72–0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42–0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97–1.51, p > 0.05). ConclusionsThis study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit..

Creating an interprofessional education package on patients' spiritual needs.

This article outlines the experiences of a Scottish healthcare chaplain. After a student nurse expressed a dated view of chaplains, I realised it was my responsibility to refresh it. After reflection I planned, developed and implemented an interprofessional education session for nursing, midwifery and allied health professional (NMAHP) students on clinical placement. I had to develop awareness of learning theories, preferences and styles, and explore different methods of delivery. Since NMAHP students can be undergraduate, postgraduate, school leavers or career changers, the session is multi-generational and interprofessional. Attendee feedback was used to review the learning session. This package was developed and shared with my team but may be of value to other healthcare chaplains or spiritual care educators to introduce spiritual care to NMAHP students on clinical placement. It will also be a useful resource for nurses, midwives and allied health professionals to expand their understanding of the role.

Perspectives on implementing an ambulatory age-friendly health system pilot project

As part of our Age-Friendly Health System journey in the ambulatory setting, our team chose to address "What matters most" (WMM) to older adults with cancer. While aligning with goals of care discussions, identifying patient priorities during each clinic visit led us to this initiative. The Gero-oncology and Gastrointestinal Clinics had >60% patient populations >65years of age and were chosen for this pilot. Collaborating with our interprofessional partners within these clinics, our group presented to the Patient and Family Advisory Council our plan to ask a patient-centered question addressing WMM in the ambulatory clinics. This council helped us craft "WHAT IS MOST IMPORTANT TO YOU DURING THIS CLINIC VISIT?" This pilot started as low tech paper card in English/Spanish presented to patients at their visit. Initially the cards were hand tabulated by Geriatric Resources Nurses (GRNs) and categorized. Examples include medication refills, test review, and plans of care. Plan-Do-Study-Act rapid tests of change discussions occurred bi-monthly. Workflow revisions occurred with the evolution to nursing entering patient's answers into the electronic health record (EHR). The high-frequency categories became multi-selection checklist in the EHR. This information was used to ensure we had resources for GRNs to address these needs. Currently the team is exploring how the WMM categories can translate to provider notes to be addressed during each visit. As the project rolls out to other ambulatory clinics, Patient Experience will monitor patient satisfaction metrics such as i nclusion in treatment decision.

Promoting Safe Mobility.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Using a Mechanical Lift at Home: Preparing family caregivers to use lifts for transfers.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Home Oxygen Therapy: Assisting and educating caregivers and those receiving supplemental oxygen.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Immunisation resources for nurses

Immunisation resources for nurses

Nursing perspectives about the critical gaps in public health emergency response during the COVID-19 pandemic.

IntroductionThe purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses.DesignWe conducted a secondary thematic qualitative analysis using grounded theory methodology.MethodsData collection occurred through semi‐structured, in‐depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.’s Public Health Emergency Preparedness Framework and inductively for emergent themes.ResultsThree themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need.ConclusionFrom a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

Book Reviews

Book Reviews

Improving transitional care communication for older Australians from hospital to home: Co-design of the TRANSITION tool.

This study aimed to develop and evaluate a communication tool to guide transitional care for older patients. Using experience-based co-design, a communication tool resulted from the triangulation of data collected from three study phases. From 2015 to 2016, semi-structured interviews and co-design focus groups were undertaken with older patients, carers and healthcare practitioners across acute, rehabilitation and community settings. The evaluation phase, conducted in 2017-2018, involved use of the communication tool by healthcare practitioners in a multidisciplinary care team with older patients in acute care and semi-structured interviews with healthcare practitioners about the acceptability and feasibility of the tool. A total of 103 patients, carers and healthcare practitioners took part. In semi-structured interviews, patients and carers reported needing to become independent in care transitions, which was supported by discussing the transitional care plan with healthcare practitioners. Interviews with healthcare practitioners identified that their need for fast and safe care transitions was supported by team discussion and by engaging patients and carers in their transitional care plan. Co-design focus group participants identified principles guiding transitional care including patient-centred communication. Data collected from semi-structured interviews and co-design focus groups were used to develop a prototype communication tool to guide conversations about discharge care between healthcare practitioners and older patients. Following use, healthcare practitioners reported that the communication tool was feasible and acceptable although some nurses perceived that transitional care was not their role. The communication tool provides an evidence-based resource for ward nurses to support transitional care continuity in multidisciplinary models.

Palliative care in home health care services and hospitals \u2013 the role of the resource nurse, a qualitative study

BackgroundThe role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established internationally and used in a wide area of clinical settings. The resource nurse is promoting evidence-based practice.Patients with life limiting conditions including cancer and other chronic diseases will likely need palliative care during the trajectory of illness. Due to the complexity of palliative care, both interprofessional help and cooperation between levels of healthcare are considered necessary.AimThe aim of this study was to explore the perceptions and experiences related to the role of the resource nurse in palliative care in the setting of home health care services and hospitals in Norway, from the perspectives of the resource nurses and the ward nurses.DesignThe study has an explorative design with a qualitative approach.MethodsEight individual interviews were conducted. Audiotaped interview material was transcribed verbatim and the data were analysed using systematic text condensation. The encoded data material provided the basis for writing analytical texts that in turn resulted in meaningful descriptions of the different categories.ResultsFour resource nurses and four ward nurses participated in individual interviews.Analysis of the data yielded three categories: 1. Expectations of better competence in the ward. 2. Expectations of better cooperation between professions and different levels of healthcare services. 3. Improvements and hindrances.ConclusionThe resource nurse role is underutilized due to heavy workload and inefficient organization of care. Improvements such as sufficient time resources, support from the ward nurse and cooperation with staff nurses, the resource nurses’ role could contribute to increased competence and cooperation interprofessionally and between levels of healthcare.

Effectiveness of testing hard-to-heal wounds for bacterial protease activity: a randomised clinical trial.

The study aimed to evaluate whether using a point-of-care test for bacterial protease activity (BPA) to target antimicrobial dressing use can improve outcomes for hard-to-heal wounds and reduce cost. Wounds asymptomatic for infection and testing positive for BPA were randomly assigned to two weeks' treatment with a silver antimicrobial dressing in addition to standard of care (SoC) (intervention group) or to SoC only (control group). The patient's outcomes were monitored for 12 weeks. The study included 100 wounds. A reduction in annualised nursing resource of 29.0% (95% confidence interval (CI): 1.9-34.1) for hard-to-heal wounds was predicted for the intervention versus control group (44±25.10 intervention group nurse/clinic visits versus 62±31.23 control group nurse/clinic visits; p=0.034). The percentage of patients reporting problems reduced for all EQ5D-3L dimensions for the intervention group, with the largest reductions in 'pain/discomfort' (-36.2%) and 'anxiety/depression' (-19.1%). Prescription of antibiotics fell by 45% for wound-related infections in the intervention group compared with the control group. In the intervention group the number of patients who did not receive a prescription was 37/50 (74%), nine (18%) patients received one prescription and four (8%) patients received two or more prescriptions. In the control group 29/50 (58%) patients did not receive a prescription, 12 (24%) received one prescription and nine (18%) patients received two or more prescriptions; p=0.068. The utility of the BPA test to reduce predicted annualised nursing time was demonstrated. The strong trend towards reduced antibiotic prescribing and improved quality of life for patients with wounds treated for BPA deserves further study.

Recognizing and Acting on Mentation Concerns.

This article is the fourth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Teaching Family Caregivers to Assist Safely with Mobility: Methods for safe patient handling can and should be used in the home.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.