Unit Patients Research Articles

ACTing Spiritually: Integrating Spiritual Care and Mental Health Care withina US Department of Veterans Affairs Inpatient Psychiatric Unit.

As a part of the VA's interprofessional fellowship in psychosocial rehabilitation, the authors developed an 8-week spirituality group manual, ACTing Spiritually, which incorporates principles of acceptance and commitment therapy (ACT) into a spirituality group protocol. The group, administered weekly as possible for 28weeks on an inpatient psychiatric unit at a veterans affairs (VA) medical center in West Haven, CT, aimed to incorporate veterans' spirituality into their mental health treatment through concepts of acceptance, values, mindfulness, and committed action. ACTing Spiritually ran in tandem with a basic ACT group and the two groups had comparable average group sizes, suggesting interest in ACTing Spiritually similarly compares to interest in a basic ACT group in this context. In addition, development of the group yielded several qualitative findings, including a discussion of the similarities and differences between ACT and spiritual care, clinical gains for chaplains conducting the group, and clinical tensions that arose through the process of integration. The study provided preliminary evidence of the potential feasibility and acceptability of ACTing Spiritually. Next steps should include a formal evaluation of its potential efficacy.

Effect of Intravenous Sodium Pentobarbital on Pain and Sensory Abnormalities in Patients with Chronic Non-Cancer Pain: Narrative Literature Review, Research Study, and Illustrative Case Reports.

Sodium pentobarbital (SP), a short- to intermediate-acting barbiturate, has limited information in the existing literature. The objectives of this study are to describe (a) the effect of intravenous (IV) SP infusion on pain and sensory abnormalities, and (b) its utility in the diagnosis and management of patients with chronic pain. A narrative review of barbiturate applications for chronic pain was followed by a pragmatic study of 176 consecutive patients admitted to an inpatient pain unit (2004-2009). We collected demographic information upon admission, diagnoses retrieved from chart review, and pain ratings and sensory abnormalities at baseline and after blinded infusion of normal saline (NS) followed by SP. The study group consisted of 83 men and 93 women (mean age 41 ± 11years); the mean NS dose was 7.8 ± 2.3 (range 2-10ml), the SP dose was 223.8 ± 88mg (range 40-420), and the numeric rating scale (NRS) baseline pain score was 6.0 ± 2. The mean reduction in NRS reached both statistical and clinical significance in 150 responders to either NS/SP or SP only. Collectively, we found (a) an extremely high rate of response to IV SP irrespective of the underlying pathology, (b) greater response for pain than for sensory abnormalities (sensory gains or deficits), (c) greater response for sensory gain than for sensory deficit, and (d) greater response for allodynia than for pinprick hyperalgesia. Illustrative case reports are also presented. IV SP infusion is a diagnostic tool that assists in elucidating pain generators and the nature of sensory abnormalities (central vs. peripheral), with effects similar to those of IV sodium amytal. The test cannot be viewed as a tell-all diagnostic modality and must be used in conjunction with clinical judgment, investigations, and psychological reports.

Oral health knowledge, attitudes, and practices of paediatric nurses caring for hospitalized children

ObjectivesNurses are well positioned to provide oral care to hospitalized children. This study explores pediatric hospital nurses’ knowledge, attitudes, practices and perceived barriers to providing oral care.MethodsUsing a descriptive cross-sectional design, previously validated surveys were adapted based on input from key stakeholders and administered to all nurses and staff providing patient care on inpatient units (N = 239) of a pediatric hospital.ResultsThe survey response rate was 40% (N = 96), providing a margin of error of 7.59% (95% C.I.). Most participants were unaware that caries is infectious (51%, n = 49) and caries-producing bacteria is transmissible (35%, n = 34). The majority (57%, n = 52) of participants did not recall oral care content within their formal education or oral care continuing education (88%, n = 81), despite high interest (87%, n = 80). Oral care was rated by most as a priority (85%, n = 81), yet the majority (74%, n = 69) believed it is under performed. More nurses with 6 or more years of experience placed a high or very high value on prioritizing oral health (p = 0.005). Furthermore, most nurses do not assess oral health on admission (63%, n = 60), routinely incorporate oral health into the care plan (45%, n = 43), or document oral care (60%, n = 56). Commonly reported barriers include lack of patient cooperation, medical status, and competing needs.Conclusions and outcomeDespite nurses valuing the importance of oral care and their willingness to learn, oral care practices are lacking, and barriers exist. Future investigation is required to further explore the findings related to barriers to care and lack of practice. These results and future findings will be used to guide institutional oral care policy and education.

SNAP: Supportive non-invasive ventilation for acute chest syndrome prevention for hospitalized children with sickle cell disease: Perspectives of patients, parents, and the healthcare team.

Acute chest syndrome (ACS) often develops during hospitalizations for sickle cell disease (SCD) vaso-occlusive episodes and may be triggered by a combination of chest wall splinting, opioid use, hypoventilation, and atelectasis. In 2017, Boston Medical Center's general pediatric inpatient unit instituted the novel use of bi-level positive airway pressure (BiPAP) as "supportive non-invasive ventilation for ACS prevention" (SNAP) to prevent ACS and respiratory decompensation. The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP. We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families. SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.

What Makes Effective Acute Geriatric Care? - A mixed Methods Study From Aotearoa New Zealand

Structured Objectives Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand.MethodThis mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital.ResultsA definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams.ConclusionsThe findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient.Implications for Public HealthThe findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms.

Blues-based stigma songwriting with adults on an acute mental health inpatient unit: A cluster-randomized trial and reflection

Self-stigma often functions as a treatment barrier for adults with mental health conditions and can hinder recovery. Blues-based stigma songwriting may constitute an empowering and engaging medium to educate people with mental health conditions about self-stigma, identify it as an oppressive social construct, and encourage treatments to augment the likelihood of recovery. The purpose of this cluster-randomized effectiveness study was to determine whether a single group music therapy songwriting intervention can impact self-stigma with adults on an acute mental health unit. Participants ( N = 131) were cluster-randomized to a single session of blues-based stigma songwriting or a control group. Experimental participants completed the Internalized Stigma of Mental Illness Inventory (ISMI) at posttest only while control participants completed the ISMI at pretest only. Although there were tendencies for the experimental group to have slightly lower mean self-stigma scores on the alienation, stereotype, discrimination, and resistance subscales as well as total self-stigma, there was no significant between-group difference. Mental health stigma is an important recovery-oriented construct and blues-based songwriting may constitute an empowering and engaging way to address this challenging topic. As educational interventions for stigma can lead to increases in self-stigma for adults with mental health conditions, larger treatment doses may be necessary to reduce it. Implications for clinical practice, limitations, and suggestions for future inquiry are provided.

Reducing Inpatient Transport Delays: The Right Patient at the Right Time

Introduction: Transportation of inpatients throughout hospitalization remains a critical aspect of patient care. Transport delays hinder the timely delivery of surgical procedures, radiology, and patient triage, consequently impacting the flow and receipt of treatment. This study reviews transport delays in a quaternary care hospital's inpatient orthopedic unit to the preoperative unit. The goal of the project was to reengineer processes for maximized efficiency and improve on-time starts for all surgical services. Methods: Manufacturing methods of an assembly-line–like model and contemporary process-improvement tools in Lean and Six Sigma were used to gauge, reengineer, and monitor processes to ameliorate patient flow. In addition to value streamlining the flow, evaluating communication triggers, eliminating redundant operations, and shifting roles and responsibilities, multiple data sources were used to assess flow for a redesign. Results: Changes in process operations led to a 40% decrease in delays. The grace period for 100 cases was decreased by 5 minutes, in addition to a savings of $110,000 in operating room costs in the first week and 3.5 full-time equivalents annually. Physician satisfaction with timely patient arrival increased in addition to a simplified workflow, which improved patient readiness on the inpatient surgical floor and increased safety. Discussion: Using data-driven approaches, overnight acuity level was removed as a barrier to the timely care of add-on cases. With a standardized process, prediction model, and simplified evidence-based communication strategies coupled with a “pull” manufacturing model, we implemented a structured, safe, and reliable method of efficient patient transport.

Risk factors and methods in suicides of elderly patients connected to mental health services from 1999-2024.

Suicide prevention is an important aspect of psychiatric care, with older men being a population identified at especially high suicide risk and a recent increase in suicides among older women. Using data collected by the region's quality assurance team, we examined all suicide deaths occurring between March 1999 and February 2024 in patients aged 60 years or older who were connected to the region's Addiction and Mental Health Program at the time of death. Data were analyzed to describe which factors were most commonly identified in suicides in older adults receiving mental healthcare. We also compared male and female cases to determine whether certain factors were more commonly observed in one gender. We identified 48 cases of suicide occurring in patients aged 60 or over. 60% of suicides occurred in males. Overdose and hanging were the most common suicide methods used, and all suicides occurring on inpatient units occurred via hanging. Depression was the most common diagnosis, and was diagnosed more frequently in suicides of female older adults. A greater proportion of suicides in older women were associated with previous history of suicide attempts. Our findings support many current best practices for suicide prevention in psychiatric care, including minimizing ligatures and anchor points on inpatient settings, assessing for and limiting access to means in individuals at-risk, and assessing suicide risk in hospitalized patients prior to passes and discharge. Recognition and treatment of depression remain important aspects in the treatment of older adults to prevent suicide.

Incidence and outcomes of pediatric patients with dual diagnosis of traumatic spinal cord injury and brain injury on an inpatient rehabilitation unit.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are diagnoses commonly encountered on the pediatric rehabilitation unit. However, there is limited evidence in the literature addressing the incidence of or rehabilitation outcomes in pediatric patients with a dual diagnosis of TBI and SCI. To determine incidence and functional outcomes of the dual diagnosis population. Retrospective cohort study. Inpatient rehabilitation unit within an academic pediatric hospital. Pediatric patients admitted to a single inpatient rehabilitation unit with a diagnosis of traumatic SCI between 2006 and 2019. Fifty-four patient records were identified and 26 met inclusion criteria. Not applicable. Presence of concomitant TBI in patients with diagnosed SCI. Seven of 26 patients were given a dual diagnosis of TBI and SCI during their initial rehabilitation hospitalization. After review of charts, authors identified 12 additional patients with suspected dual diagnoses based on injury characteristics and symptoms. There were no significant differences in functional outcomes across diagnosis groups. Incidence of dual diagnosis among pediatric patients with traumatic SCI was initially found to be 27%; the retrospective review indicated that TBI may be underdiagnosed in this patient population, and the dual diagnosis incidence may be as high as 73%. All patients had improved functional outcomes during their rehabilitation stays regardless of presence or absence of TBI.

Perspectives of Mental Health Nurses About Sexual Safety in Acute Inpatient Mental Health Units.

The overall aim of this study is to explore the views of mental health nurses (MHNs) about the sexual safety of consumers receiving care in acute inpatient units. In Australia, people accessing mental health inpatient units have reported feeling unsafe while receiving care including experiences of sexual harassment and abuse from other patients. There has been no study to date that has explored the views of the MHNs providing care. An explorative descriptive qualitative study. Data were collected through semi-structured interviews involving n = 8 MHNs working on a metropolitan acute inpatient unit recruited using purposive convenience sampling. Data were analysed using thematic analysis. The findings of this study highlighted the themes of 'It's everyone's job to keep the patient safe', 'Going over expectations', 'Impact on patients' and 'Built environment'. Participants in this study believed that the sexual safety of patients in the inpatient unit is everyone's responsibility and that it was important during the admission process to ensure patients are aware of how to both seek help if needed and ensure that their actions or behaviours do not pose sexual safety concerns in others. Ensuring sexual safety in the mental health inpatient units is a complex issue that requires evidence-based multipronged interventions involving all key stakeholders within the units.

Children's Hospital Resource Utilization During the 2022 Viral Respiratory Surge.

Multiple viral respiratory epidemics occurred concurrently in 2022 but their true extent is unclear. To aid future surge planning efforts, we compared epidemiology and resource utilization with prepandemic viral respiratory seasons in 38 US children's hospitals. We performed a serial cross-sectional study from October 2017 to March 2023. We counted daily emergency department (ED), inpatient, and ICU volumes; daily surgeries; viral tests performed; the proportion of ED visits resulting in revisit within 3 days; and proportion of hospitalizations with a 30-day readmission. We evaluated seasonal resource utilization peaks using hierarchical Poisson models. Peak volumes in the 2022 season were 4% lower (95% confidence interval [CI] -6 to -2) in the ED, not significantly different in the inpatient unit (-1%, 95% CI -4 to 2), and 8% lower in the ICU (95% CI -14 to -3) compared with each hospital's previous peak season. However, for 18 of 38 hospitals, their highest ED and inpatient volumes occurred in 2022. The 2022 season was longer in duration than previous seasons (P < .02). Peak daily surgeries decreased by 15% (95% CI -20 to -9) in 2022 compared with previous peaks. Viral tests increased 75% (95% CI 69-82) in 2022 from previous peaks. Revisits and readmissions were lowest in 2022. Peak ED, inpatient, and ICU volumes were not significantly different in the 2022 viral respiratory season compared with earlier seasons, but half of hospitals reached their highest volumes. Research on how surges impact boarding, transfer refusals, and patient outcomes is needed as regionalization reduces pediatric capacity.

Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus.

The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

Closer to Home: A Quality Improvement Initiative to Optimize Satellite Site Bed Capacity.

The coronavirus disease 2019 pandemic resulted in the underutilization of inpatient beds at our satellite location. A lack of clarity and standardized admission criteria for the satellite led to frequent transfers to the main campus, resulting in patients traveling larger distances to receive inpatient care. We sought to optimize inpatient resource use at the satellite campus and keep patients "closer to home" by admitting eligible patients to that inpatient unit (LA4). Our aim was to increase bed capacity use at the satellite from 45% to 70% within 10 months. Our process measure was to increase the proportion of patients needing hospitalization who presented to the satellite emergency department (ED) and were then admitted to LA4 from 76% to 85%. A multidisciplinary team used quality improvement methods to optimize bed capacity use. Interventions included (1) the revision and dissemination of satellite admission guidelines, (2)steps to create shared understanding of appropriate satellite admissions between ED and inpatient providers, (3) directed provider feedback on preventable main campus admissions, and (4) consistent patient and family messaging about the potential for transfer. Data were collected via chart review. Annotated run charts were used to assess the impact of interventions over time. Average LA4 bed capacity use increased from 45% to 69%, which was sustained for 1 year. The average percentage of patients admitted from the satellite ED to LA4 increased from 76% to 84%. We improved bed capacity use at our satellite campus through transparent admission criteria and shared mental models of patient care needs between ED and inpatient providers.

Long-term colchicine for the prevention of vascular recurrent events in non-cardioembolic stroke (CONVINCE): a randomised controlled trial

Anti-inflammatory therapy with long-term colchicine prevented vascular recurrence in coronary disease. Unlike coronary disease, which is typically caused by atherosclerosis, ischaemic stroke is caused by diverse mechanisms including atherosclerosis and small vessel disease or is frequently due to an unknown cause. We aimed to investigate the hypothesis that long-term colchicine would reduce recurrent events after ischaemic stroke. We did a randomised, parallel-group, open-label, blinded endpoint assessed trial comparing long-term colchicine (0·5 mg orally per day) plus guideline-based usual care with usual care only. Hospital-based patients with non-severe, non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack were eligible. The primary endpoint was a composite of first fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation (defined as an admission to an inpatient unit or a visit to an emergency department that resulted in at least a 24 h stay [or a change in calendar date if the hospital admission or discharge times were not available]) for unstable angina. The p value for significance was 0·048 to adjust for two prespecified interim analyses conducted by the data monitoring committee, for which the steering committee and trial investigators remained blinded. The trial was registered at ClinicalTrials.gov (NCT02898610) and is completed. 3154 patients were randomly assigned between Dec 19, 2016, and Nov 21, 2022, with the last follow-up on Jan 31, 2024. The trial finished before the anticipated number of outcomes was accrued (367 outcomes planned) due to budget constraints attributable to the COVID-19 pandemic. Ten patients withdrew consent for analysis of their data, leaving 3144 patients in the intention-to-treat analysis: 1569 (colchicine and usual care) and 1575 (usual care alone). A primary endpoint occurred in 338 patients, 153 (9·8%) of 1569 patients allocated to colchicine and usual care and 185 (11·7%) of 1575 patients allocated to usual care alone (incidence rates 3·32 vs 3·92 per 100 person-years, hazard ratio 0·84; 95% CI 0·68-1·05, p=0·12). Although no between-group difference in C-reactive protein (CRP) was observed at baseline, patients treated with colchicine had lower CRP at 28 days and at 1, 2, and 3 years (p<0·05 for all timepoints). The rates of serious adverse events were similar in both groups. Although no statistically significant benefit was observed on the primary intention-to-treat analysis, the findings provide new evidence supporting the rationale for anti-inflammatory therapy in further randomised trials. Health Research Board Ireland, Deutsche Forschungsgemeinschaft (German Research Foundation), and Fonds Wetenschappelijk Onderzoek Vlaanderen (Research Foundation Flanders), Belgium.

Integrating behavioral, psychodynamic, recovery-oriented, and trauma-informed principles to decrease aggressive behavior in inpatient care.

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nursing categories’ perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design

BackgroundThere is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories’ perceptions of the practice environment and quality of care and the association between the variables.MethodsThis study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236).ResultsAll nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale.ConclusionImproving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.

Reducing costs and improving patient recovery through a nurse-driven centralized spinal orthoses program on a post-surgical unit: A quality improvement initiative

BackgroundAn external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients. ObjectiveTo develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs. DesignQuality improvement project evaluated as a retrospective interrupted time-series SettingPost Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida ParticipantsVendor Program: 134 patients; Centralized Program: 155 patients MethodsThe nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques. ResultsThe centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 – 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319. ConclusionsThe results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses. Tweetable abstractA nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.

Talking about borderline personality disorder, shaping care: The multiple doings of narratives.

This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change.

Determinants and risk factors for renal damage: where do patients hospitalized for severe anorexia nervosa stand? A multi-center study

BackgroundAlthough renal damage is increasingly reported among the most undernourished patients with Anorexia Nervosa (AN), it remains underestimated in current practice, and often associated with acute dehydration. The purpose of our study was to evaluate the frequency, the extent, and the risk factors of renal involvement among adolescents and adults hospitalized in specialized units for AN.MethodsIn this multi-center study, 197 consecutive participants were included, aged 13–65, from 11 inpatient eating disorder psychiatric units. Information on the course of AN, clinical characteristics, biological data, and medication were collected.ResultsAt admission, mean BMI was 13.1 (± 1.6) kg/m2 for a mean age of 20.74 (± 6.5) years and the z-score was − 3.6 (± 1.33). Six participants (3.0%) had hyponatremia, four (2.0%) had hypokalemia, and nine (4.5%) had hypochloremia. The Blood Urea Nitrogen/Creatinine ratio was over 20 for 21 (10.6%) participants. The mean plasma creatinine was 65.22 (± 12.8) µmol/L, and the mean eGFR was 74.74 (± 18.9) ml/min. Thirty- five participants (17.8%) had an eGFR > 90 ml/min, 123 (62.4%) from 60 to 90 ml/min, 35 (17.8%) from 45 to 60 ml/min, and 4 (2%) under 45 ml/min. In multivariate analysis, only BMI on admission was a determinant of renal impairment. The lower the BMI the more severe was the renal impairment.ConclusionWhen eGFR is calculated, it highlights renal dysfunction found in severe AN requiring hospitalisation in specialized units. The severity of undernutrition is an independent associated factor. Kidney functionality tests using eGFR, in addition to creatinine alone, should be part of routine care for patients with AN to detect underlying renal dysfunction.

Evaluation of Reliability Between Race and Ethnicity Data Obtained from Self-report Versus Electronic Health Record.

Disparities based on perceived race and ethnicity exist in all fields of medicine. Accurate data collection is crucial to addressing these disparities, yet few studies have evaluated the validity of data gathered. This study compares self-reported race and ethnicity data, considered the gold standard, with data documented in the electronic health record (EHR), to assess the validity of that data. Data from self-reported questionnaires was collected from adolescents admitted to a psychiatric inpatient unit from February 2019 to July 2022. Demographic questionnaires were self-administered as part of a larger battery completed during the admission process. Data was compared to demographic information collected from the hospital's EHR for the same patients and time. In a sample of 1191 patients (ages 11-18, 61.9% female, 89% response rate), substantial agreement was observed for Hispanic ethnicity (κ = 0.64), while agreement for specific racial groups ranged from slight to substantial (κ = 0.10-0.63). In addition, it was noted that there was discrepancy between multiracial identification, with 17.1% of patients identifying as more than one race in self-reported data compared to 3.1% in EHR data. The findings from this data set highlight the need for caution when using EHR data to draw conclusions about health disparities. It also suggests that the method of data collection meaningfully influences the responses patients provide. Addressing these challenges is essential for advancing equitable healthcare and mitigating disparities among patients.