Staff Talking Research Articles

Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement.

The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends-"care partners"-to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan "People remember less than half of what their doctors say," which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners.

Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study.

Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting. In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds. The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently. Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.

The psychiatric ward environment and nursing observations at night: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nursing observations at night are conducted on psychiatric wards to ensure the safety and well-being of patients as well as to reduce the risk of suicide or severe harm. To our knowledge, no studies have examined the lived experience of the psychiatric ward environment and of nursing observations at night. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The main complaint from patients was the constant interruption of their sleep, as most of the patients in this study were observed 2-4 times an hour. Their sleep was interrupted by (a) the light from torches shone into their faces by staff checking on their safety, (b) the noises produced by the opening and closing of bedroom/ward doors, and/or (c) staff talking to each other during the observation. Patients also reported that they found having somebody enter the room in the middle of the night intimidating and unsettling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Poor sleep has been associated with an increase in suicide risk and mental health problems. Identifying practices that promote sleep hygiene is vital. The study could be used to develop a Quality Improvement Project to improve patients' sleep and perhaps reduce duration of stay. ABSTRACT: Introduction A fundamental component of nursing care is observations at night to ensure the well-being of patients. However, there is no literature on the lived experience by inpatients of such observations or of the general environment of a psychiatric ward at night. Aim/Question This study aims (a) to understand the lived experience of being an inpatient on a psychiatric ward at night with a focus on intermittent observations and (b) contribute to developing a tool to monitor the psychiatric ward environment for use in quality improvement projects. Method Semi-structured interviews were conducted with twelve inpatients from five psychiatric wards who had experienced intermittent observations at night. These interviews were subsequently transcribed and analysed using content analysis. Results Environmental disturbances including light and noise, invasion of privacy and safety considerations on the ward all contributed to sleep disturbance. The unintended consequences of disturbances caused by intermittent night observations, and by staff in general and other patients formed the core of the inpatients' experience. We developed a clinical tool that could be used to identify the factors that are relevant on an individual ward. Discussion Participants interviewed unanimously agreed that poor sleep quality had a significant negative impact on their psychological and social well-being. These were discussed in relation to the environment and the experience of observations at night. Implications for nursing practice Deprivation of inpatients' sleep is currently under-reported, and the usefulness of intermittent observations at night in psychiatric wards is questioned. Much could be done to adjust the environment at night to support quality sleep and improve psychiatric symptoms. This paper aims to highlight the lived experience of patients to help bring improvements.

Registered Nurses' experiences of patient participation in hospital care: supporting and hindering factors patient participation in care.

Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care. The aim of this study was to describe Registered Nurses' experiences with patient participation in nursing care including their barriers and facilitators for participation. The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data. Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme 'partnering with patients' was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients' heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside. It all came down to partnering with the patient and participants described how they made an effort to respect the patients' view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients' taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.

Are Mealtime Best Practice Guidelines for Child Care Centers Associated with Energy, Vegetable, and Fruit Intake?

Mealtime best practices for obesity prevention in child care have been developed from experimental studies and expert opinion. Our objective was to describe adherence to best practices in child care centers and to evaluate the association between mealtime practices and children's dietary intake. We conducted an observational study of 349 preschoolers, ages 36 to 72 months, from 30 child care centers in Cincinnati, Ohio (November 2009 to January 2011). Trained observers recorded providers' behaviors related to six mealtime best practice recommendations and documented children's intake (n = 60 group lunches). General linear mixed models were used to evaluate the association between practice use and children's total energy (caloric consumption) and fruit and vegetable consumption. Adherence to individual mealtime best practices was variable (0%-77%). Staff sitting with children at lunch was associated with lower energy intake and higher vegetable intake. Staff eating some of the same foods was associated with higher energy intake and higher vegetable intake. Staff encouraging children to try new/less-favorite foods more than once was associated with lower fruit intake. Staff having general conversations with children (not addressed in recommendations) was associated with lower vegetable intake. Family-style meal service, staff talking about healthy foods, and staff helping children assess hunger before seconds were not significantly associated with intake. Few mealtime best practices were associated with dietary intake. Given the number of meals children consume in child care and the prevalence of childhood obesity, efforts to identify mealtime practices that improve children's dietary intake are crucial for obesity prevention.

When Patient Rights and Physician Beliefs Collide

When Patient Rights and Physician Beliefs Collide

护士夜查房对老年患者睡眠的影响及护理对策

目的：调查研究护士夜间工作对住院老年患者睡眠状况的影响，针对性实施个体化护理服务，最大限度降低护士夜查房对住院老年患者睡眠干扰，提高住院老年患者的睡眠质量。方法：对石家庄某三甲医院110名住院老年患者进行问卷调查及访谈，了解患者睡眠状况及影响因素。结果：42例住院后睡眠质量高于家庭占42.00%。23例睡眠质量无明显差异占23.00%。35例睡眠质量低于家庭占35.00%，其中12例需要服用安眠药解决入睡困难(9例是住院3天后首次开始服用)。依照得分中位数，对老年患者睡眠影响由大到小排序为：护士夜间操作治疗、医护人员谈话声、巡视病房、心理因素、身体不适、翻身拍背、床位不适、护士对其他病人的操作治疗、缺乏常规睡前安排。结论：护士夜查房是影响老年患者睡眠的重要因素，通过合理的护理管理、恰当的护理措施、完善的工作方针可以提高老年患者睡眠质量。 Objective: To research the impact of nurses’ night work on the sleep of elderly patients, targeting on the implementation of individualized care, decreasing the disturbance of nurses’ night rounds on hospitalized elderly patients to the largest extent and improving sleep quality of hospitalized elderly patients. Methods: Make questionnaires and interviews on 110 hospitalized elderly patients of a top three hospital in Shijiazhuang, to understand the patients’ sleep and its influence factors.Results: 42 patients show higher sleep quality in hospital than at home, accounting for 42.00%; 23 patients show no significant difference in sleep quality, accounting for 23.00%; 35 patients show lower sleep quality, accounting for 35.00%, of which 12 cases need to take sleeping pills to solve sleep problems (9 patients start to take pills after 3 days in hospital). In accordance with the average score, with descending order, the impacts on elderly patients are ranked as: the treatment of nurses at night, medical staff talking, visiting the wards, psychological factors, physical complaints, turning and patting back, uncomfortable beds, nurses’ operating on other patients and lack of regular bedtime arrangements. Conclusion: Nurses’ night round is an important influencing factor on sleep in elderly patients. Through reasonable care management, appropriate care measures and great working guideline, the sleep quality of elderly patients can be improved.

Noise stress for patients in hospitals – A literature survey

The growing number of publications on noise in hospitals reflects not only a rising interest in this theme during the last decades, but also an increasing noise exposure of the patients: the average SPL reported in literature between 1960 and 2005 has risen from 57 to 72 dBA in daytime and from 42 to 60 dBA at night. The hospitals in question differ substantially with regard to type of construction, technical equipment, and organizational issues. But especially for intensive care units (ICUs), the main sources of noise described in international research are similar: sounds from technical appliance such as alarms, noise caused by the staff talking or handling material, and communication systems such as overhead paging. With regard to patients in ICUs, sleep disturbances in terms of falling asleep and sleeping through are the greatest problem as assessed by questionnaires or by physiological measurements. They might have harmful effects on the outcome of the medical treatment influencing the duration of recovery and the need for sedative medication. Several intervention programmes for noise reduction are reported in literature combining a variety of methods such as acoustical insulation, sound level reduction with regard to equipment, and especially behavior modification of the staff.

Sound Levels in Nursing Homes

Noise in nursing homes remains problematic despite attempts to create homelike environments. The purpose of this study was to examine nursing home sound levels. Eight nursing units in four not-for-profit nursing homes were studied. The findings of this study show sound levels ranged from 24 to 89.6 dBA, with averages of 52.91 to 59.46 dBA. Twenty-six percent of the sound was created by staff talking, while only 3% was directed at or included the residents. Findings suggest mealtime has the potential to create louder sounds, and staff talking may contribute significantly to overall sound levels.

Towards an Ideal Paradigm

Byline: T. Asokan A great deal has changed in the 200 years since Reil coined the term 'Psychiatry' into medicine. The concept of custodial asylum prevailed in the initial period of Psychiatric history during which biological concepts held sway. Then the doctrine of Psychoanalysis came increasingly to the fore. The period between 1970 and the present time is witnessing the emergence of Biological psychiatry again with a vengeance and psychodynamic explanations have largely been unhorsed. The history of Psychiatry reveals jolting changes and discontinuities that are less common in other specialities. This is because, certain details with reference to underlying causes were unidentifiable and un-understandable. With the lack of solid pathophysiology or understanding of the mechanisms of disease, it cannot delineate disease entities on the basis of anatomical pathology. Thus the discipline is subject to faddism-anything could be true and nothing can be disproven. Thomas Kuhn coined the term 'Paradigm' to denote conceptual structure within which scientific work occurs. It is the sum of underlying assumptions. Theories and models which are specific become hypotheses and function within a paradigm. In Psychiatry, no single paradigm is able to explain fully the nature of mental illness, relation of mind to brain, definitions of cause, course and treatment of specific pathologies, guidance on how to cope with mental illness. The medical Philosopher Lawrie Reznek (1987) said, Concepts carry consequences-classifying one way rather than another has important implications for the way we share towards such things Kraepelin was committed to a biological ontology. Neo Kraepelinians gave up this biological ontology, at least overtly but extended Kraepelin's nosology beyond the major psychoses. In the Victorian period there was a challenge to construct knowledge base to underpin a form of medical authority over lunacy. There was an editorial in the Journal of Mental Disease (the former title of British Journal of Psychiatry) in 1858 which in two sentences captures the essence Insanity is purely a disease of Brain; The Physician is now the responsible guardian of the lunatic and must ever remain so For over fifty years, this concept remained in the ascendency about lunacy. The asylum system was taken over by Biodeterminism and contributed to the Zetgeist of eugenic thought of western intellectual culture. There was a fundamental incompatibility between the eugenic view harboured by the Victorian asylum doctors and the grim reality of the fine officers and Gentlmen breaking down with predictable regularity in the trenches of great war. To offer an eugenic view for the neurotic reactions among the traumatised soldiers was tantamount to reason. At this point the monopoly of biodeterminism was broken and neurosis and psychosis came within the ambit of Psychiatry and psychoanalysis. Between world wars a compromise was worked out with medical Psychotherapy and Biological Psychiatry and Eclecticism provided a middle position. Eclectic Psychiatrist is one who practises a moderate type of Psychiatry, using whatever seems likely to work, while deliberately avoiding the more extreme schools. In an Eclectic department of Psychiatry, it is possible to hear the staff talking about one patient in behaviourist terms, about the next from a strictly biological point of view and the third wholly in psychodynamic terms. Practitioners try to fit the theory to the patient, rather than vice versa. Eclecticism became a mark of moderation in an intellectually unstable world. It leads the Clinical Psychiatrist into a good deal of tightrope walking. An eclectic Psychiatry mirrors the diverse world wracked with uncertainty and overloaded with information. Eclecticism means borrowing freely from styles which suffer only in aesthetic grounds. Adolf Meyer's views were stemmed out of British Clinical Psychiatry as a form of psychiatric orthodoxy. …

Sound Level Exposure of High-Risk Infants in Different Environmental Conditions

To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU. Descriptive and comparative design. Convenience sample of 134 infants at a southeastern quarternary children's hospital. A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions. The renovated NICU was, on average, 4-6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels. Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.

Acoustical Design Features associated with Noise Level in Health Facilities: The Case of Dialysis Facilities

Objective The purpose of this study was to determine acoustical design features associated with different noise levels measured in dialysis facilities. Dialysis facilities were selected because they have noise sources that were similar across facilities but varying acoustical design features. Research Design Specific acoustical features in patient treatment areas were observed in 55 dialysis facilities in Texas. Decibel level was recorded from a sample of patient stations in each facility. Sources of noise and ability of staff and patients to control loudness were documented. Analysis Nonparametric correlations and analysis of variance were used to test for acoustical features associated with differences in mean level of noise between facilities, controlling for observer bias and measurement error. Key Findings Noise levels in all facilities exceeded levels appropriate for patient care environments. Televisions and staff talking contributed significantly to the noise level measured in an open plan treatment environment. Acoustical tiles, wall covering, wall cabinets, and shelves did not alter the high noise level. Noise level did vary according to acoustical screening effects of treatment room layouts. Sound reverberating within a bay of patient stations contributed to higher noise levels. A pinwheel layout was significantly quieter, reflecting sound more randomly because of the geometry of treatment stations configured at right angles. Conclusion Noisy environments increase stress and decrease work performance—a condition detrimental to effective and efficient health care. The only acoustical feature associated with differences in noise level was layout of patient stations. The different screening effects of the various layouts were significant in modifying the noise level in the treatment environment.

Interactions between adults with profound intellectual disability and staff

Two main studies of interaction between adults with intellectual disability and staff are reported. The first varied five interactive strategies with nine clients. Results showed that increased positive behaviour from clients was associated with staff talking with them and using social routines. No such increase was observed when staff made their responses contingent on clients, a finding which was supported by the second study carried out with 16 staff-client pairs. In this second study no correlations were found between behaviour during interaction and developmental age.

Information Systems in Management Science—Is Information Systems Talking to Itself?

The title for this Column was suggested by a continuing discussion at TIMS meetings, “Is TIMS talking to itself?” Both questions are part of the broader question of “Is staff talking to itself?”, whether that staff is in the area of management science, information services, economics, planning, or what have you. The fact is that top managers are bombarded with ideas about the latest fad. They are told that if they do not have a management information system, or a management sciences group, or econometrics input, or a five-year plan, that they are just not going to be able to compete. The business schools are probably the worst offenders, but the Wall St. Journal, Fortune, and the New York Times all help out, and these topics become grist for the luncheon circuit mill. It is no wonder that under this pressure, the top managers cave in and do the vogue thing. Then a group springs forth within the company, and begins to try to find a role within the company where none existed before. There are two roles that such groups can play in any organization, a line role or a consulting role.