Relocating to a New OR Suite: Practical Observations

Operating room renovation projects usually involve updated technology and processes that can create challenges for administrative leaders (eg, maintaining a surgery schedule during a move) and require staff member adjustments. The perioperative team of a large tertiary care and trauma center relocated from a 35-year-old suite to a new suite, which required years of planning, months of training, and weeks of organizing. This article discusses the processes and observations that helped ensure a smooth transition to the new space. Early planning allowed time for leaders to make equipment decisions, develop and test new processes, and train staff members. The actual move required detailed planning, thorough execution, patience, and flexibility to ensure a safe transition. Perioperative leaders balanced operational needs with relocation plans to maintain patient and staff member safety. Open, multidisciplinary communication combined with staff member participation and buy-in contributed to an efficient, safe move at this facility.

Ionospheric Narrowband and Wideband HF Soundings for Communications Purposes: A Review

High Frequency (HF) communications through ionospheric reflection is a widely used technique specifically for maritime, aeronautical, and emergency services communication with remote areas due to economic and management reasons, and also as backup system. Although long distance radio links can be established beyond line-of-sight, the availability, the usable frequencies and the capacity of the channel depends on the state of the ionosphere. The main factors that affect the ionosphere are day-night, season, sunspot number, polar aurora and earth magnetic field. These effects impair the transmitted wave, which suffers attenuation, time and frequency dispersion. In order to increase the knowledge of this channel, the ionosphere has been sounded by means of narrowband and wideband waveforms by the research community all over the world in several research initiatives. This work intends to be a review of remarkable projects for vertical sounding with a world wide network and for oblique sounding for high latitude, mid latitude, and trans-equatorial latitude.

The "Obiettivo Antibiotico" Campaign on Prudent Use of Antibiotics in Sicily, Italy: The Pilot Phase

The issue of antimicrobial resistance (AMR) is a focus of the World Health Organization, which proposes educational interventions targeting the public and healthcare professionals. Here, we present the first attempt at a regionwide multicomponent campaign in Sicily (Italy), called "Obiettivo Antibiotico", which aims to raise the awareness of prudent use of antibiotics in the public and in healthcare professionals. The campaign was designed by an interdisciplinary academic team, and an interactive website was populated with different materials, including key messages, letters, slogans, posters, factsheets, leaflets, and videos. The campaign was launched in November 2018 and, as of 21 December 2018, the website had a total of 1159 unique visitors, of which 190 became champions by pledging to take simple actions to support the fight against AMR. Data from social media showed that the audience was between 18 and 54 years of age, with a high proportion of female participants (64%). Interestingly, the LinkedIn page received more than 1200 followers, and Facebook 685 followers. The number of actions taken (pledges) by the audience was 458, evenly divided between experts (53%) and the general public (47%). Additional efforts are needed to reach more people, thus future efforts should focus on further promotion within the Sicilian region to sustain the engagement with the campaign.

Evaluation of communication to general practitioners when opioid-naïve post-surgical patients are discharged from hospital on opioids

BACKGROUND

To address the opioid crisis, much work has focused on minimizing opioid supply to surgical patients upon hospital discharge. Research is limited regarding handover to primary care providers. The aim of this study was to evaluate the communication of post-operative opioid prescribing information provided by hospitals to general practitioners (GPs).

METHODS

This study comprised two components. First, a retrospective audit of discharge summaries for opioid-naïve surgical patients supplied with an opioid on discharge was conducted to evaluate accuracy of opioid documentation and presence of an opioid management plan. Second, a survey was distributed to GPs to seek their opinions regarding adequacy of communication about hospital-initiated opioids in discharge summaries, challenges experienced in opioid management and suggestions for improvement.

RESULTS

Discharge summaries for 285 patients were audited. Twenty-seven (9.5%) patients had no discharge summary completed. Of the remaining 258, 63 (24.4%) summaries had at least one discrepancy between the opioid(s) listed and the opioid(s) dispensed. Only 33 (12.8%) summaries contained an opioid management plan. From 57 GP-completed surveys, 41 (71.9%) GPs rarely or never received an opioid management plan from hospital surgical units and 34 (59.7%) were dissatisfied/very dissatisfied with information provided about opioid supply and management. Qualitative responses highlighted difficulties GPs experience managing opioid treatment for post-surgical patients after discharge, differing patient expectations and the need to improve communication at times of transition.

CONCLUSION

When opioid-naive patients are discharged from hospital on opioids, communication from hospitals to GPs is poor. Future interventions should focus on strategies to improve this.

A qualitative study of nurses' perspective about the impact of end-of-life communication on the goal of end-of-life care in nursing home

BACKGROUND

With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end-of-life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end-of-life and organise the care plan accordingly.

AIM

To explore nurses' perspective about the process by which end-of-life communication impacts on the goal of end-of-life care in nursing home residents.

DESIGN

A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi-structured interviews. A combined approach of analysis that incorporated a data-driven inductive approach and a theory-driven one was adopted.

RESULTS

Twelve themes described how end-of-life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient-centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end-of-life communication (i.e. healthcare professional-resident and healthcare professional-family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision-making), while curative-oriented and palliative-oriented care goals emerged as consequences.

CONCLUSION

This study provides insight into the nursing perspective of end-of-life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end-of-life communication, which contributed to the transition towards palliative-oriented care by using and improving knowledge about family cares' and resident's preferences for end-of-life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision-making.

Motivational Interviewing: A Communication Tool to Promote Positive Behavior Change and Optimal Health Outcomes

Motivational interviewing (MI) is a collaborative communication style that can be integrated into everyday practice to improve conversations and serve as a catalyst for behavior change. This article reviews the fundamental principles and basic skills of MI. It discusses how MI has evolved from a therapeutic modality to a conversational style, applicable in the school setting and specifically for school nurses. The article provides an overview of how MI can be used by school nurses, challenges they may face, and resources to support implementation.

Development and Validation of a Scale to Measure Nurse/Medical Resident Physician Collaboration

Introduction

The purpose of this pilot study is to investigate the reliability of an interprofessional collaboration measurement scale used for nursing interactions with resident physicians. To date, the collaboration between nurses and residents has not been adequately investigated and a validated tool specifically for this purpose is not yet available. Our objective is to adapt a previously validated interprofessional scale for health care settings to the specific nurse/resident physician collaboration.

Methods

In 2019, nurses from two hospitals were contacted via email and were invited to complete an anonymous survey that asked about the nurses' interaction and collaboration with resident physicians.

Results

Our inquiry of 850 nurses with 59 completing a survey, returned a response rate of about 7%. Internal consistency for the scale was very high (alpha = 0.92) with no single item disproportionally reducing the reliability of the scale.

Conclusion

Despite the limited sample size of the present pilot study, this scale was effective for examining nurse/resident collaboration. Further research will seek to expand our sample size and include measures of concurrent validity.

End-of-life communication in advanced cancer: international trends (2009-2014)

OBJECTIVE

To examine trends in end-of-life communication with people with cancer in general practice.

METHODS

Mortality follow-back survey among general practitioners (GPs) in representative epidemiological surveillance networks in Belgium (BE), the Netherlands (NL) and Spain (ES) in 2009-2010 (ES: 2010-2011) and 2013-2014. Using a standardised form, GPs registered all deceased adult patients in their practice and reported for five end-of-life care topics whether they had been discussed with the patient. Non-sudden cancer deaths were included (n=2306; BE: 1233; NL: 729; ES: 344).

RESULTS

A statistically significant increase was found between 2009/2010 and 2014 in the prevalence of communication about diagnosis (from 84% to 94%) and options for end-of-life care (from 73% to 90%) in BE, and in GPs' awareness of patients' preferences for medical treatment and a proxy decision-maker in BE (from 41% and 20% up to 53% and 28%) and the NL (from 62% and 32% up to 70% and 52%). Communication about options for end-of-life care and psychosocial problems decreased in the NL (from 88% and 91% down to 73%) and ES (from 76% and 77% down to 26% and 39%).

CONCLUSION

Considerable change in GP-patient communication seems possible in a relatively short time span, but communication cannot be assumed to increase over time. Increasing specialisation of care and task differentiation may lead to new roles in communication for healthcare providers in primary and secondary care. Improved information sharing between GPs and other healthcare providers may be necessary to ensure that patients have the chance to discuss important end-of-life topics.

In Their Own Words: Experiences of Caregivers of Adults With Cancer as Expressed on Social Media

PURPOSE

To explore caregivers' writings about their experiences caring for adult individuals with cancer on a social media health communication website.

PARTICIPANTS & SETTING

Journal entries (N = 392) were analyzed for 37 adult caregivers who were posting on behalf of 20 individuals with cancer. CaringBridge is a website used by patients and informal caregivers to communicate about acute and chronic disease.

METHODOLOGIC APPROACH

A retrospective descriptive study using qualitative content analysis of caregivers' journal entries from 2009 to 2015.

FINDINGS

Major categories identified in caregivers' online journals included patient health information, cancer awareness/advocacy, social support, caregiver burden, daily living, emotions (positive and negative), and spirituality.

IMPLICATIONS FOR NURSING

Nurses often recommend using social media as a communication strategy for patients with cancer and their caregivers. The findings from this study provide potential guidance nurses may wish to offer caregivers. For example, nurses may talk with caregivers about how and what to post regarding treatment decisions. In addition, nurses can provide support for caregivers struggling with when and how often to communicate on social media.

Social Interaction in Walking Groups and Affective Responses Among Japanese Older Adults

This study examined whether satisfaction with social interactions and the number of people interacted with during walking groups is associated with affective responses among older adults. Twenty-six older adults were asked to participate in five walking group sessions. The participants walked together for 40-50 min. In every session, the participants reported their affective responses to walking (positive engagement, tranquility, and negative affect), their level of satisfaction with the social interactions experienced, and the number of people interacted with during the walk. The available data were from 107 person-sessions. Multilevel models revealed that, although a higher number of people interacted with was not significantly associated with improvements in any affective responses, higher satisfaction with the interactions was significantly associated with improvements in positive engagement at both the within- and between-person levels. This study found that higher satisfaction with the interactions was associated with desirable affective responses among older adults.

Palliative care for people living with cardiac disease

Many cardiovascular diseases lead to heart failure, which is a progressive syndrome causing significant distress and limiting the quality of life, despite optimal cardiologic treatment. It is estimated that about 26 000 people in Poland suffer from advanced heart failure, and this number is growing. That is why palliative care (PC) dedicated to people living with end‑stage cardiac diseases should be urgently implemented in Poland. Well‑organized PC may not only relieve symptoms and improve quality of life in people living with cardiac diseases not responding to treatment but also support patients and their families during the dying process. Palliative care in patients with cardiac diseases should be continued during the end-of-life period. It should be implemented regardless of prognosis, and adjusted to patients' needs. Two approaches to PC are presented in this expert opinion. The first one (generic) is provided by all medical professionals incorporating PC principles into the usual patient care. The second approach, namely, specialized PC, is ensured by a multiprofessional team or at least a PC specialist who received appropriate training in PC. The model of needs-based (not prognosis-based) implementation of PC is discussed in this paper. Symptom control, support in decision-making, and sensitive, open communication are considered integral elements of PC interventions. Medical professionals developing PC in Poland should think about groups of patients with special needs like those with valvular heart disease, grown‑up congenital heart disease, and pulmonary arterial hypertension, as well as elderly people. This consensus document presents main recommendations for future PC organization in Poland. Among others, we suggest changing the Polish National Health Fund reimbursement rules regarding PC and improving cardiologist education on PC.

Adolescents and Young Adults with Cancer Using a Symptom Heuristics App: Provider Perceptions and Actions

Purpose: This study examined health care providers' perceptions of the usefulness and ease of use of a symptom heuristics app delivered via a tablet computer as a resource for understanding symptom experiences of adolescents and young adults (AYAs) with cancer. AYAs' app-generated symptom reports were compared with providers' documentation of AYAs' symptoms. Methods: This multisite study included responses from 86 AYAs 15-29 years of age who completed the Computerized Symptom Capture Tool (C-SCAT) before two scheduled visits for chemotherapy. After each visit, their providers completed a survey addressing their perspective of: (1) the usefulness of data provided by the C-SCAT to understand the AYAs' symptom experience, and (2) the nature of the discussion of symptoms with the AYA. An electronic health record review compared symptoms that AYAs identified by using the C-SCAT with providers' documentation of symptoms. Results: One hundred forty-four complete surveys were returned after 162 visits. Fifty percent (n = 72) of responses reported that the C-SCAT helped identify the patient's symptoms, and 53% (n = 76) reported that it helped identify the patient's priority symptoms. Providers also reported higher patient engagement and more focused discussions regarding symptoms. They reported that use of the C-SCAT facilitated the development of symptom management plans. Priority symptoms were documented more frequently than nonpriority symptoms (54% vs. 32.7%; p < 0.01) as was a plan for managing priority symptoms (33.7% vs. 17.9%; p < 0.01). Conclusion: Use of the C-SCAT enhanced providers' understanding of AYAs' symptom experiences. Further research is needed to demonstrate the effectiveness of the C-SCAT as a resource to improve symptom management among AYAs with cancer.

Development and Evaluation of an SBAR-based Fall Simulation Program for Nursing Students

PURPOSE

The purpose of this study was to develop an Situation-Background-Assessment-Recommendation (SBAR) fall simulation program for Korean nursing students and to evaluate its effectiveness.

METHODS

This study used a single-blind randomized control pretest-posttest design. The 54 nursing students in their third semester at a college in Korea were selected through convenience sampling (SBAR group 26, handoff group 28). The SBAR-based program was provided to the experimental group, while the general handoff-based program was given to the control group. The program was designed for a total of three sessions each and no more than 120 minutes each. Measurement variables included the knowledge, skill, attitude, communication ability, and its clarity related to falls. The data were analyzed with x² test, t test, and repeated measures of ANOVA using the SPSS 18.0 program.

RESULTS

The SBAR group showed the improved fall-related skill and communication clarity compared with the handoff group. There was a significant difference in the fall-related knowledge only in a time-dependent manner before and after intervention, while there was no statistically significant difference in the attitude and communication ability related to falls.

CONCLUSIONS

SBAR-based simulation program revealed positive results in terms of patient safety of nursing college students compared with the general handoff-based method. Therefore, the SBAR-based simulation program is expected to be used as an educational intervention for nursing students not only to improve abilities in reporting and communication but to prevent or handle patient safety accidents efficiently.

The Experience of Using Video Support in Ambulance Care: An Interview Study with Physicians in the Role of Regional Medical Support

Background: In order to facilitate more effective patient assessment and diagnostic support by improving the flow of information between ambulance nurses (AN) and physicians in the role of regional medical support (RMS), an application was developed for transmitting real-time video images. Objective: The objective of this study was to elucidate the physicians’ experiences using a video application to support the assessment and triage procedure in ambulance care, when patients are deemed to not have an urgent need for emergency care. Design: The design for this research was a qualitative interview study. Ten physicians, working as RMS in ambulance care, were purposively selected to participate. The telemedicine concept studied consisted of a real-time video image application, in addition to the currently used mobile phone. When a patient was deemed eligible for inclusion in the study, the ambulance nurse (AN) contacted the RMS via telephone to initiate a video consultation. To elucidate the RMS experience of using the application, a conventional content analysis was performed. Results: The main theme “a feeling of being satisfied through a sense of increased patient safety” emerged from the following two categories: adds value in diagnosing situations (three subcategories, i.e., support in diagnosing, usability, and technical weakness) and increase communication opportunities (four subcategories, i.e., assessing the level of care, patient dialogue, professional communication, and team learning). Conclusions: Physicians in the role of RMS experienced a positive impact using video image transmission in addition to the currently used mobile phone. This evaluation was derived from a sense of increased patient safety in the assessment situation when patients were considered to be triaged to self-care.

Perception of Corporate Hypocrisy in China: The Roles of Corporate Social Responsibility Implementation and Communication

In the past two decades, corporate hypocrisy has become a phenomenon that cannot be ignored in Corporate Social Responsibility (CSR) practice (Wagner et al., 2009) and has thus become a concern for management scholars (Cho and Lee, 2019). Using smartPLS, based on attribution theory, this paper takes 28 Chinese listed enterprises as examples to explore the influence of CSR motivation on its communication and implementation, as well as the impact of CSR implementation and promotion on consumers' perception of corporate hypocrisy. The research finds a negative correlation between value-driven motivation and corporate hypocrisy and a positive correlation of performance-driven motivation and stakeholder-driven motivation with corporate hypocrisy. The theoretical contribution of this paper is mainly reflected in the following four aspects. (1) It describes the scale of CSR implementation research and enriches the measurement tools of CSR implementation. (2) It enriches and expands research results in the field of CSR motivation perception. From the perspective of CSR and attribution theory, this study explores the influence of consumers' perception of CSR motivation on CSR communication and CSR implementation. (3) It supplements research results in the field of corporate hypocrisy. The influence of CSR communication and CSR implementation on corporate hypocrisy is clarified. (4) It clarifies the impact of CSR communication on CSR implementation so as to help enterprises better match CSR communication strategy and CSR implementation in practice and reduce consumers' perception of corporate hypocrisy. It is suggested that enterprises find their own positioning on CSR motivation, which provides a reference with which enterprises can make better decisions on CSR communication strategy after implementing CSR behavior and provides empirical evidence for the research on CSR motivation perception and corporate hypocrisy in China.

Optimal care for mother and child: Safety in obstetric anaesthesia

Anaesthetists play a major role in the perioperative treatment of patients, sharing responsibility for quality and safety in anaesthesia, intensive care, emergency and pain medicine. Several aspects lead to the fact that these issues are particularly important in obstetric anaesthesia. As morbidity and mortality are dramatically higher than in a nonpregnant population in this age, there is room for improvement even in regions with a well-developed healthcare system. Adverse events and complications during birth often hit fast, hard and unexpectedly and require immediate patient-centred care. This mostly involves an interdisciplinary and interprofessional approach that includes obstetricians, neonatologists, anaesthetists, intensivists and of course midwives and nurses. In this article, established standards and emerging possibilities to improve patient safety by developing a culture of awareness for safety aspects, education, establishing safety and communication strategies and performing teamwork- and simulation training are discussed. Apart from these issues, self-care of clinicians is vital in the prevention of adverse events, because fatigue and burnout are associated with increased rates of complications.

Improving Physician-patient and Physician-nurse Communication and Overall Satisfaction Rates: A Quality Improvement Project

Introduction

Communication between healthcare providers and patients is a key component associated with the quality of healthcare and patient satisfaction. Often, simple communication skills may be insufficient to sustain a successful provider-patient relationship. The aim of this project was to assess and improve patient and nurse satisfaction with physicians via improvement in physician-patient and physician-nurse communication to a level greater than 90%.

Methods

Initial surveys were given to the patients and nurses on admission to the regular nursing floor to assess current satisfaction rates. Afterward, visual handouts were given that provided details about the current medical team members and the role of each team member. which were updated daily along with the medical plan. Surveys were then handed out to the patients and their nurses at the time of discharge. All surveys were conducted anonymously.

Results

A total of 26 surveys (n = 13 patients, n = 13 nurses) were collected and analyzed for a preliminary assessment. Surveys concluded that 68.8% of patients were satisfied with the patient-provider communication; similarly, 74.4% of the nurses were satisfied with the nurse-provider communication. In the next six weeks, visual handouts were implemented. During this period, surveys involving a total of 40 patients and 40 nurses were collected. The results after the intervention revealed that 93.3% of patients were satisfied with the patient-provider communication, and 94.7% of nurses were satisfied with the nurse-provider communication. Post-intervention, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) displayed an improvement in physician communication, reaching the expected goal of 84.4%.

Conclusion

Ineffective communication often goes undetected in many healthcare settings, causing serious effects on the health and safety of patients, and may ultimately jeopardize overall satisfaction. Literature has shown a positive correlation between patient satisfaction and improved clinical outcomes. Using visual aids and updating medical care plans on a daily basis are simple yet effective tools to improve communication. Written materials should be created in a patient-friendly manner to enhance communication, clarity, and understanding.

Zika Inquiries Made to the CDC-INFO System, December 2015-September 2017

We examined Zika-related inquiries to CDC-INFO, the national contact center for the Centers for Disease Control and Prevention, to identify potential communication gaps. The most frequently asked questions related to travel or geographic location of Zika (42% of all inquiries), information about laboratory testing (13%), or acquiring a Zika test (11%).

Sexual Activity and Substance Use Among Adolescents and Young Adults Receiving Cancer Treatment: A Report from the PRISM Randomized Controlled Trial

Purpose: Despite health implications, sexual activity and substance use among adolescents and young adults (AYAs) receiving cancer treatment are understudied. Methods: AYAs 12-25 years of age participated in a randomized controlled trial testing the efficacy of a resilience intervention. They were fluent in English and either diagnosed with new cancer (NC) or advanced cancer (AC). At baseline and 6 months, participants self-reported sexual activity and substance use. We describe the percentage of AYAs who endorsed each behavior and a count of total behaviors endorsed by each respondent. We describe frequencies by sex/gender (male/female), age (<18/≥18), and disease status (AC/NC). Results: Participants (N = 92) were majority white/Caucasian (57%), 12-17 years old (73%), and diagnosed with leukemia/lymphoma (62%); 32% had AC. Responses were not associated with the intervention; hence, we summarized data from the whole cohort. At both time points, median behavior endorsed was 2. At baseline and follow-up, 87% and 81% endorsed at least 1 behavior: 13% and 15% were sexually active, 75% and 73% of whom used birth control inconsistently; and 22% and 22% reported drinking alcohol, 31% and 27% using prescription opioids/sedatives, 19% and 22% using other drugs, and 9% and 7% using tobacco. Young adults engaged in most behaviors more frequently than adolescents (e.g., 48% vs. 12% alcohol at baseline); males engaged in sexual activity more frequently than females (e.g., 20% vs. 5% sexually active at baseline); and AYAs with NC engaged in most behaviors more frequently than those with AC (18% vs. 0% sexually active at baseline). Conclusion: AYAs engage in sexual activity and substance use during cancer treatment.

Information Overload: A Method to Share Updates among Frontline Staff during the COVID-19 Pandemic

Since COVID-19 was classified as a pandemic, the stream of important information from multiple sources is constant and always changing. As the pandemic evolves, the need to report relevant information to frontline providers remains crucial. A 1-page centralized document termed a "quicksheet" was developed to include guidelines, policies, and practical information and to serve as a reference tool for our clinicians. It was updated and distributed frequently, up to once daily. It was initially embraced as an important resource for resident physicians and then quickly adopted by the entire department as a necessary reference and communication tool during the ongoing crisis. The quicksheet has been a beneficial tool to distill and organize the most important and relevant information for frontline staff, and we hope that it can serve as a template for departments and health care workers in other hospital systems to adopt.

Relative risks and odds ratios: Simple rules on when and how to use them

AIM

Relative risks and odds ratios are widely reported in the medical literature, but can be very difficult to understand. We sought to further clarify these important indices.

METHODS

We illustrated both relative risks and odds ratios using bar charts, then looked at the types of study for which each statistic is suited. We demonstrated calculation of relative risks and odds ratios through analysis of tabled data from a recent published longitudinal study, using a 2 × 2 table and R, the open-source statistical programming language. Simple rules for when and how to use relative risks and odds ratios are presented.

CONCLUSION

Understanding the difference between relative risks and odds ratios and when and how to use them may aid clinical interpretation, dissemination and translation of research findings.

Communication issues contributing to medication incidents: Mixed-method analysis of hospitals' incident reports using indicator phrases based on literature

AIM

To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients.

BACKGROUND

Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement.

DESIGN

A sequential exploratory mixed-method design.

METHODS

Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting.

RESULTS

Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines.

CONCLUSIONS

The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication.

RELEVANCE TO CLINICAL PRACTICE

Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.

Wishes and needs of nursing home residents and their relatives regarding end-of-life decision-making and care planning-A qualitative study

AIMS AND OBJECTIVES

To explore wishes and needs, such as existing and preferred communication processes, of residents and relatives regarding medical and nursing planning at the end of life.

BACKGROUND

Nursing home residents are a relevant target group for advance care planning (ACP) due to their high age and multimorbidity. Their relatives seem to be important partners in terms of communication and their documentation of wishes and needs.

DESIGN

A qualitative descriptive design was used.

METHODS

Thirty-two guideline-based interviews with nursing home residents (n = 24) and relatives (n = 8) were conducted in nursing homes in Germany (n = 7). All interviews were analysed by content-structured content analysis. The COREQ checklist was used to document reporting of the study.

RESULTS

Residents particularly express wishes and needs regarding their health, like the desire to maintain or improve one's current state of health and to be active and mobile and also regarding their social situation, for example the well-being of relatives and beloved ones. A limited group of people was identified with whom residents spoke about issues such as preparedness and self-determination. These were mainly their relatives. Relatives themselves have a need for more communication. Various communication barriers could be identified.

CONCLUSION

Residents express diverse and partly explicit wishes and needs. Although many of the respondents had already drafted advanced directives, the demand for offers of communication to plan ahead for the end of life remains clear. The results indicate the unconditional participation of relatives and people close to the residents, if they are available.

RELEVANCE TO CLINICAL PRACTICE

Derivations for a target group-related ACP concept in the study region are identified. Besides the involvement of relatives, nurses could also be involved in the communication and decision-making process of residents in nursing homes under certain conditions.