Total building commissioning

Healthcare facilities are generally commissioned according to standards laid down by specific stipulations or the consultant engineers. This commissioning process is normally only concerned with the physical functioning of the building services and is aimed at ensuring the installed services are operating according to the engineers' specifications. It is no longer acceptable just to conduct a thorough clean, commonly called a hospital clean, and consider that as adequate for patient occupation, writes Kevin Moon.

Managing under-nutrition in a nursing home setting

This article considers interventions and strategies used to manage the problems of an undernourished older adult residing in a nursing home. A brief introduction to the patient is followed by a discussion of the process of identifying care needs, and the planning and provision of care based on current evidence and outcome evaluation. The crucial role of nurses in meeting the nutritional needs of older patients is also emphasised.

Assessing the quality of nursing work life

Traditionally, nursing has measured job satisfaction by focusing on employees' likes and dislikes. However, job satisfaction is an unsatisfactory construct to assess either the jobs themselves or employees' feelings about work sinceas much as 30% of the variance explained in job satisfaction surveys is a function of personality, something employers can do little to change. Based on socio-technical systems theory, quality of nursing work life (QNWL) assessments focus on identifying opportunities for nurses to improve their work and work environment while achieving the organization's goals. Moreover, some evidence suggests that improvements in work life are needed to improve productivity. Therefore, assessing QNWL reveals areas for improvement where the needs of both the employees and the organization converge. The purpose of this article was to assess the QNWL of staff nurses using Brooks' Quality of Nursing Work Life Survey.

State systems development in high-risk newborns in the neonatal intensive care unit: identification and management of sleep, alertness, and crying

The state system is a fundamental component of newborn neurodevelopmental function and demonstrates the newborn's underlying neurologic and behavioral competence. The role of the state system in newborn developmental assessment reflects the newborn's ability to respond to the environment. This overview examines the importance of the state system as a significant developmental process, identifies specific variations in sleep and wakefulness, and describes behavioral patterns of state in full-term as well as high-risk newborns. Specific intervention techniques are outlined for caregivers and parents, which address consolability, adjusting the environment, handling, and interactions. This information contributes to the nurse's ability to identify and assess neurobehavioral integrity and provides appropriate behavioral individualized developmental interventions during neonatal care.

Nurses' perceptions of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment--Part II

The purpose of this study was to examine the effect of a renal nursing professional practice model (PPM) on nurses'perceptions of empowerment, characteristics of practice environments and the impact on nursing care outcomes in a university-based teaching hospital in Canada. Quantitative and qualitative methodologies were used. This paper will focus on the qualitative results. Content analysis was the data analysis method used. The following themes emerged: 1) Attunement, familiarity/knowing the patient, going the distance, 2) Patient outcomes, consistency and continuity of care, autonomy/taking the initiative, 3) Nurse rewards: satisfaction and accountability, empowerment/input, and 4) Facilitating systems: communication, support and assignment. The quantitative results had a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Practice Environment Scale of the Nursing Work Index (NWI-PES) and organizational relationships (p =.016) measured by the Conditions of Work Effectiveness II (CWEQ-II) questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.

Posttraumatic stress symptoms in the pediatric intensive care unit

PURPOSE

Children who experience acute injury or illness severe enough to result in a pediatric intensive care unit (PICU) stay are at risk for posttraumatic stress symptoms, as are their parents. A distinction is made between injury-related traumatic events, illness-related traumatic events, and treatment-related traumatic events, all of which contribute to this risk.

CONCLUSIONS

This paper reviews what the PICU experience is like for children and their parents, the emerging literature on posttraumatic stress symptoms in PICU patients and their parents, and current knowledge regarding risk and resiliency factors for these children.

PRACTICE IMPLICATIONS

Children hospitalized in the PICU should be monitored for posttraumatic stress disorder during and after their stay. Risk and resiliency factors are a focus for practice and for future research.

A person-centered workplace: the foundation for person-centered caregiving in long-term care

OBJECTIVE

This study seeks to understand what role managers and the work setting they create play in a nursing facility that seeks to make a transition to person-centered care.

DESIGN

The study uses a human-relations framework to test 3 propositions: Managers play a critical role in the satisfaction, loyalty and commitment (ie, the engagement) of their staff; managers construct a person-centered workplace that deepens staff engagement; and engaged staff promote the well-being of the residents.

SETTING AND PARTICIPANTS

The study draws on responses of Certified Nurse Assistants (CNAs) and families of residents collected in 2 satisfaction surveys conducted in 156 nursing facilities. It also uses state inspection survey data from the same facilities.

MEASUREMENTS

The analysis uses measures of satisfaction, loyalty, and commitment as well as 6 scales of quality; 3 as they pertain to staff and 3 as they pertain to families. Data reduction, correlational, and risk analyses assess how managers and the work environment affect CNA engagement and the quality of caregiving.

RESULTS

Management approach and the work environment are powerful predictors of CNA satisfaction, loyalty, and commitment. The work environment also correlates with how families and state surveyors evaluate quality in a nursing facility.

CONCLUSION

The managers and the work setting they create hold primacy in the work life of the CNAs. Caring managers fashion a person-centered workplace conducive to turn workers into devoted caregivers. When the workplace adds quality to the life of caregivers, the caregivers add quality to the life of the resident.

Coaching: a different approach to the nursing dilemma

While the current nursing shortage continues, many new approaches from sign-on bonuses to "fast track training" are being suggested and implemented to ameliorate the situation. Yet, even with these expanded opportunities turnover is still too high. Recent studies suggest embedded factors called fit, links, and sacrifice exist between the employer and employees including nurses that account for current employees staying on their job. Creating a better understanding of embedded issues and creating an open but confidential environment to deal with conflict issues and job problems is suggested as a way to reduce turnover. A specific issue such as an unfavorable job assignment or more complex issues such as unmet expectations can cause conflict and job dissatisfaction. It is suggested that a coaching model can be used to understand the issues that create conflict and provide a method for resolution of job dissatisfaction.

Managing ambiguity and danger in an intensive therapy unit: ritual practices and sequestration

This paper reports on a particular aspect of a larger ethnographic study of nursing culture in an intensive therapy unit (ITU), accomplished through participant observation over a 12-month period, followed by interviews with 15 nurses. The paper suggests that the ITU environment is perceived as 'dangerous', its dangerousness stemming from the ambiguity of its patients' conditions. Drawing on anthropological concepts of liminality, pollution, anomaly and breaching of boundaries, the paper identifies various ambiguities inherent in ITU patients' conditions. It then explores the ways in which these anomalies are managed through sequestration and other ritual and symbolic practices. Notwithstanding the undoubted scientific reasons for particular nursing practices, the paper argues that there are also ritual and symbolic elements serving other more complex purposes, both protecting patients and staff and symbolising the highly valued phenomenon of keeping patients safe. The paper identifies a contradiction inherent in nursing work in this locale inasmuch as rituals and symbolism coexist with technical and research-based elements of nursing care.

Patient satisfaction and high-reliability organizations: what's the connection?

So how do we get there? Wagner and Harter (2006) report that it is apparent that managers who can make all of this happen view their work beyond profitability. Their motivation is created from deeply held beliefs about the solemn responsibility of management for those around them. When we view the patient satisfaction scores on the public ally reported Web sites, we will have a clear view into how the organization has eliminated negative variability and has also managed to engage the hearts and minds of their employees and their patients.

Challenges in delivering safe patient care: a commentary on a quality improvement initiative

The specific aim of this commentary is to identify the challenges identified by nurses in the delivery of safe patient care. In reporting, some of the messages emanating from the research and policy literature, the paper highlights the importance of taking a system approach to the investigation of patient safety failures, the conflicting evidence relating to patient deaths as a result of failures in safety, and the underlying importance of culture. The paper outlines the reasons why patient safety has become so prominent, and provides a brief description of some of the definitions and terminology in current use. The commentary articulates a number of challenges in the delivery of safe care as identified by nurses during a recent quality improvement initiative, and these are organized under the themes of organizational context, working environment, and the organization and management of care. In conclusion, the paper describes the implications arising from the quality improvement initiative and the need for further research exploring the nature of safety culture in health-care organizations.

Community hospital successfully implements eRecord and CPOE

Despite media attention on converting the nation's paper-based medical record systems to electronic systems, few hospitals, and even fewer community hospitals, have done so. University of Pittsburgh Medical Center St. Margaret has converted to a comprehensive electronic health record system, known as eRecord, in a short time. The authors describe key factors that were critical to the success of the conversion, along with positive results on quality of care.

Evaluation of a forensic psychiatric setting to provide a graduate nurse programme

There has been growth in the number and diversity of models of Australian graduate nurse programmes in psychiatric nursing. Programmes have also been established in specialist areas, and evidence is needed regarding best models of graduate nurse programmes and the ability of specialist areas to prepare nurses for psychiatric nursing. This paper reports on a qualitative project that examined the adequacy of a forensic psychiatric hospital to provide a graduate nurse programme. Individual, semistructured interviews were undertaken with nurses participating in the programme, and nurses who had completed the programme and had remained at the hospital or were nursing in other areas. Participants identified that the environment was safe and supportive of professional practice and development, and that skilled nurses were willing to encourage and teach graduates. Processes such as orientation, preceptorship and academic study were appreciated; however, their colleagues' willingness to be available, to teach, and to support were more valued. Participants reported that they felt confident and prepared as psychiatric nurses. Although limitations of undertaking a graduate nurse programme in a forensic setting were identified, the participants from past programmes who had gone on to work in other services did not report that their nursing careers had been disadvantaged. It can be concluded that as long as the context of the programme has adequate resources to support and assist graduates to develop the skills, knowledge and attitudes of psychiatric nursing, then the specialist nature may not be a limitation.

Jordanian patients’ perception of stressors in critical care units: A questionnaire survey

BACKGROUND

Critical care units' CCUs environment has been regarded as a leading stressor because of the complex nature of patient's health problems that require an extensive use of very sophisticated technology. Multiple and complex care predominates in CCUs have been described by patients to be stressful and emotionally demanding.

RATIONALE

Number of CCUs in Jordan has been increasing and so does the advanced technology, which calls for adaptability in dealing with unit stressors as they affect patient recovery and rehabilitation.

OBJECTIVES

To identify the principal physical and psychological stressors as perceived by Jordanian patients in CCUs and to examine the effects of selected patients' characteristics on their perception of stressors.

METHODS

In this cross-sectional study, data was collected from 165 patients, 2-3 days after being discharged from CCUs in two Jordanian governmental hospitals. A structured interview guide including the Intensive Care Unit Environmental Stressor Scale was used.

RESULTS

Having tubes in nose or mouth, being in pain, not able to sleep and hearing the buzzers and alarms from the machinery, being thirsty, and not being in control of your-self were considered by patients as the main stressors. Psychological stressors were the least stressful items identified by patients. Marital status, educational level, age, and income were the most significant characteristics which affected patients' perception of stressors.

CONCLUSIONS

The findings suggest that single and older patients with low income and low education experience more difficulties than their counterparts. Nurses must utilize more effective communication techniques and interventions to relieve patients' pain, and provide an atmosphere in which rest is possible, with less light, noise, and the fewest possible interruptions. Although the results of this study indicate the need to provide the best possible physical care, it is equally important to give adequate attention to patients' and families' psychological aspects.

Keeping Patients Safe: a collaboration among nurse administrators and researchers

Translating the recommendations from the Institute of Medicine's landmark report, Keeping Patients Safe: Transforming the Work Environment of Nurses, into practice and healthcare policy will require an extensive collaboration among nurse administrators and nurse researchers. The insights and skills of both groups are critical for evaluating the recommendations and their implications for practice, for filling gaps in research, and for influencing significant health system change.

Nurses' perceptions of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment--Part I

A transformational nursing professional practice model (PPM) was developed and implemented in the London Health Sciences Centre's renal program. The purpose of this study was to examine the impact of a renal nursing PPM on nurses'perceptions of empowerment, characteristics of practice environments, and nursing outcomes. Quantitative and qualitative methodologies were used in this study. This paper will focus primarily on the quantitative results. The qualitative results are presented in Part II (Harwood, Ridley, Lawrence-Murphy, White, Laschinger, Bevan, & O'Brien, in press). A "then-and-now" design was used. There was a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Nursing Worklife Index-Practice Environment Scale (NWI-PES) and organizational relationships (p = .016) measured by the Conditions of Work Effectiveness II (CWEQ-II) Questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.