Understanding clinical expertise: nurse education, experience, and the hospital context

Barriers to the success of cardiopulmonary resuscitation teams in emergency departments: A perspective from nurses

BACKGROUND

Cardiopulmonary arrest is one of the most important emergency situations in hospitals. Although cardiopulmonary resuscitation has long been the first step in these conditions, the low success rate of this process is still a major concern in treatment systems. Therefore, identifying the barriers and causes of failure of the cardiopulmonary resuscitation team has become an important factor in improving the results. The present study was conducted to identify the barriers to the success of cardiopulmonary resuscitation teams in emergency departments.

METHODS

A descriptive-analytical study was conducted in the emergency department of teaching hospitals in Qazvin, Iran 2023-2024. Using available sampling, 198 emergency department nurses were included in the study. Nurses were included in the study if they had at least 6 months of work experience in the emergency department, had at least a bachelor's degree, and experienced at least one cardiopulmonary resuscitation operation. The exclusion criteria were incomplete completion of the questionnaires and withdrawal from the study for any reason. The data was collected using the demographic characteristics checklist and the questionnaire on barriers to the success of the cardiopulmonary resuscitation team. Data analysis was performed using SPSS-24 software and descriptive and inferential statistics. The significance level of all tests was considered less than p < 0.05.

RESULTS

The mean age of the participants was 30.96 ± 5.15. Out of 198 nurses participating in the study, 125 were female (63.1%) and the rest were male. According to the results, the main barriers to the success of the cardiopulmonary resuscitation team in the emergency department are related to the individual and professional characteristics of the resuscitation team members with a score of 2.50 ± 0.38 and the least reason is related to the program and educational facilities dimension with a score of 2.32 ± 0.50. In the patient characteristics dimension, the initial rhythm (2.70 ± 0.58) and in the individual and professional characteristics of the resuscitation team members, the lack of skilled and experienced people (2.62 ± 1.51) were the main barriers to the success of the cardiopulmonary resuscitation team. From the nurses' point of view, in the dimension of resuscitation team management, the absence of an effective leader in the team (2.41 ± 0.64), in the dimension of equipment and devices needed for resuscitation, the absence and unpreparedness of resuscitation equipment and devices in the department (2.53 ± 0.55), and in the dimension of program and educational facilities related to resuscitation, the lack of adequate and appropriate educational facilities and equipment (2.40 ± 0.64) were the main barriers to the success of the cardiopulmonary resuscitation team. The results of the t-test showed that there is no significant relationship between age, gender, and educational qualification with the average score of the whole questionnaire (P > 0.05).

CONCLUSIONS

The results of this study showed that the individual and professional characteristics of cardiopulmonary resuscitation team members are the weak points and the most important barriers to the success of this team in the emergency department. Therefore, it is possible to reduce the barriers to the success of cardiopulmonary resuscitation and increase the survival rate of cardiopulmonary resuscitation by using experienced, skilled, and highly knowledgeable staff. Reducing or eliminating these barriers requires a detailed policy of managers and planners in individual, equipment, and training dimensions.

Leader perspectives on the "experience-complexity gap": Recommendations to fortify the nursing workforce

BACKGROUND

Reported workforce shifts, characterized as the "experience-complexity gap," threaten nurses' ability to deliver safe, high-quality care. Addressing this threat requires a robust understanding of the current state, which leaders in practice settings are well-positioned to elucidate.

PURPOSE

Describe practice leaders' perceptions of (a) new-to-practice nurses' (NTPNs) ability to practice competently, (b) the current composition of nursing teams, and (c) the impact of team composition on quality and safety, experienced nurses, and leaders.

METHODS

A web-based survey was administered to practice leaders across the country. Responses were analyzed using descriptive statistics and conventional content analysis.

DISCUSSION

Approximately 45% of respondents believe NTPNs practice competently. Specific skills gaps, measures to support NTPNs, the strain placed on experienced nurses to maintain the standard of care, generational conflict, and perceived risks to quality and safety are described.

CONCLUSION

These findings should inform academic and practice leaders' partnered efforts to implement competency-based education.

The development of the Postdoctoral Nurses Competence Scale: A Delphi consensus and content validity study

BACKGROUND

PhD prepared nurses advance nursing science through research and integration of findings into practice. They demonstrate expertise in research, education, patient care, and policy. Various professional competencies are required for success in research, clinical practice, and education. Assessment of professional competencies is expected to stimulate competence and career development.

AIM

To reach consensus on professional competencies, develop an instrument to measure professional competencies of PhD prepared nurses and assess the content validity of the instrument.

METHOD

A Delphi consensus and content validity study was conducted using online questionnaires completed by international PhD prepared nurse researchers. The relevance of and agreement with the competencies were measures using Likert-scales and open-ended questions to determine consensus. The Postdoctoral Nurses Competence Scale was developed, and its content validity evaluated.

RESULTS

Initially, four of 15 competencies were deemed 'very' or 'fairly' important by 18 PhD prepared nurses. In the second round with 13 adjusted competencies, eight competencies were rated 'very' or 'fairly' important. The content validity index scored 0.91.

CONCLUSION

Consensus was reached on most professional competencies, and the 13-item self-assessment instrument demonstrated excellent content validity. Further research is recommended to evaluate additional clinimetric properties before use of the instrument.

Effectiveness of the Pediatric Nursing Excellence Model on Nurses' Knowledge and Practice in Pediatric Orthopedic Surgery Care: A Randomized Controlled Trial

BACKGROUND

Pediatric orthopedic nursing requires specialized competencies to optimize patient outcomes, particularly in the complex realm of pediatric surgery. This study explores the effectiveness of the Pediatric Nursing Excellence (PNE) Model in enhancing nurses' knowledge and clinical practice in providing perioperative care for pediatric orthopedic patients in tertiary care inpatient settings.

METHODS

A double-blind, randomized controlled trial was conducted from February to July 2024, involving 100 nurses from two tertiary care hospitals in Tanta, Egypt. Participants were randomly assigned to receive PNE Model training (n = 50) or routine care (n = 50). Nurses' knowledge, practical skills, and adherence to PNE principles were assessed at baseline, immediately post-intervention, and after one, three, and six months using validated tools.

RESULTS

The intervention group showed significantly greater improvements in knowledge (20.62 ± 6.7 vs. 8.16 ± 5.5, p < 0.001) and practice scores (62.28 ± 4.1 vs. 40.06 ± 14.7, p < 0.001) post-intervention, sustained over six months. Path analysis revealed that the PNE Model enhanced nursing practice directly (β = 0.25, p < 0.001) through improvements in engagement and adherence to excellence principles and indirectly (β = 0.53, p < 0.001) by significantly enhancing nurses' knowledge (β = 0.70, p < 0.001), which in turn positively influenced their clinical practice (β = 0.75, p < 0.001). Post-intervention, 82% of nurses in the intervention group achieved high levels of professional excellence, compared to 8% at baseline (p < 0.001).

CONCLUSIONS

The PNE Model demonstrates robust effectiveness in enhancing nurses' knowledge, clinical practice, and professional excellence in pediatric orthopedic surgery care, with sustained long-term benefits. This evidence supports implementing specialized nursing education models to improve pediatric care quality in orthopedic settings.

A longitudinal assessment of factors affecting training transfer among new clinical nurse specialists

Objective

This study aimed to explore the determinants influencing training transfer and evaluate how those factors change over time among nurses who graduated from clinical nurse specialist training to provide a theoretical basis for improving the training transfer of clinical nurse specialists (CNSs).

Methods

A quantitative longitudinal survey with four rounds of data collection was utilized to measure the influencing aspects of training transfer from June 2018 to December 2019. A total of 46 new CNSs participated in this study, including 30 and 16 nurses receiving training programs for CNSs in Infusion, Wound and Ostomy. The factor influencing training transfer (FITT) questionnaire was used to collect data for the first month (time 1), the third month (time 2), the sixth month (time 3), and the first year (time 4) after training. This questionnaire contains 53 items divided into five dimensions, including managerial support (20 items); hindrance in the organization (6 items); the validity of the training program (10 items); organizational and personal facilitators (11 items); and personal attitudes towards training transfer (6 items).

Results

The influencing factors of CNSs transfer decreased over time, with managerial support, hindrance in the organization, the validity of the training program, and personal attitudes towards training transfer changing statistically over time (P < 0.05), and no statistical difference in organizational and personal facilitators over time (P = 0.229). During early after training (the first month and the third month after training), hindrance in the organization is the biggest obstacle to training transfer. During the later of training (the sixth month and first year after the training), managerial support is the biggest obstacle to training transfer. Overall level of influencing factors of training transfer decreased in three months after training among Infusion nurses (P < 0.001), and Wound and Ostomy nurses decreased in the first year after training (P < 0.001).

Conclusions

The trend and level of training transfer predictors decreased depending on time. Clarifying the factors influencing transfer and its patterns may help nursing managers enhance the implementation and impact of nurse specialist training.

SIN-BARRSS - Developing a mnemonic to support nurses' participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement

OBJECTIVES

To develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round.

RESEARCH METHODOLOGY/DESIGN

Appreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts.

SETTING

Large (44 beds) critical care unit in the United Kingdom.

MAIN OUTCOME MEASURES

Interprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses' contributions to ward round discussions (frequency and focus).

RESULT/FINDINGS

Interprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility.

CONCLUSIONS

The implementation of a mnemonic supported bedside nurses' contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities.

IMPLICATIONS FOR CLINICAL PRACTICE

A mnemonic can provide a structure which supports bedside nurses' contributions in ways that make good use of bedside nurses' professional expertise and most up to date knowledge of patients' clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses' confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.

Nursing privilege: A concept analysis

AIM

The study aimed to provide a comprehensive concept analysis of nursing privileges by elucidating its meaning and implications within the healthcare context.

DESIGN

A concept analysis paper.

METHODS

A comprehensive literature review was conducted from nursing and healthcare databases, professional nursing organizations, and regulatory bodies. Documents reviewed include research studies, policy documents and professional guidelines. The study employed Walker and Avant's eight-step method of concept analysis. This involved identifying the uses of the concept, its underlying attributes and referents, and constructing model, borderline, related and contrary cases. The antecedents, consequences and empirical referents of nursing privileges were also determined.

RESULTS

The analysis uncovered vital attributes defining nursing privileges, encompassing professional authority, autonomy, access to resources, information, influence, decision-making power, respect and recognition. Additionally, antecedents and consequences of nursing privilege were identified, spanning development and resource access, as well as professional satisfaction and enhanced patient care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nurses' knowledge regarding recommended practices on using surgical attire in operating theatre

Background

To reduce the risk for surgical site infections, nurses in the operating theatre environment must have knowledge of and adhere to recommended practices regarding the use of surgical attire.

Aim

To evaluate the effect of an educational intervention on nurses' knowledge related to recommended practices regarding the use of surgical attire in operating theatre.

Setting

Operating theatres in two public and two private hospitals in the Eastern Cape province, South Africa.

Methods

An educational pilot study, using a quasi-experimental, two-group pre- and post-test design, was conducted. A convenience sample of n = 85 nurses was purposively allocated to a control group and an intervention group. An existing educational intervention consisting of an interactive training session, brochures based on the Association of periOperative Registered Nurses' (AORN) guidelines and a summary of these guidelines was implemented for the intervention group, while the control group received only the summary of the guidelines. Data were collected through self-administered pre- and post-test questionnaires from March 2019 to August 2019.

Results

The overall knowledge score for nurses in the intervention group post-intervention improved with a large significance (p ≤ 0.000 and Cohen's d = 1.26).

Conclusion

The intervention has shown potential to improve the knowledge related to recommended practices of nurses in operating theatres regarding the use of surgical attire.

Contribution

This pilot study encourages the implementation of the intervention on the use of surgical attire but requires further development and a wider implementation to measure its impact, and access to resources, enhancing and sustaining its success.

Prerequisites for entry to advanced nurse practitioner studies- a qualitative study of Norwegian nurse anesthetist students' experiences

BACKGROUND

Nurse anesthesia is acknowledged as advanced practice nursing, and requires independency in patient monitoring and clinical decision-making. In Norway, 2022, a prerequisite to nurse anesthesia education programs of at least two years of clinical nursing experience prior to entry, was removed. The consequences of removing the prerequisite of clinical nursing experience prior to entering the nurse anesthetist education program on academic progression or on students' qualifications after completion of the program remain unexplored. Hence, the purpose of the current study was to explore nurse anesthetist students' experiences of the impact their previous clinical nursing experience had on their academic progression.

METHODS

A qualitative design with semi-structured individual interviews was used. The sample consisted of 12 nurse anesthetist students at the end of the education program. The data were analyzed using thematic analysis in-line with recommendations from Braun & Clarke.

RESULTS

Two main themes with in total six subthemes were identified, namely 1) Experience develops non-technical skills, with subthemes (a) feeling secure in task management, (b) recognizing different situations, (c) understanding my role in teamwork, and 2) Integration of non-technical and technical skills, with subthemes (a) possessing procedural competence, (b) taking responsibility in medication administration, and (c) including a patient-centred approach. Previous clinical experience as a nurse prior to entry to a NA education program had provided a basis of non-technical and technical competencies, that supported further learning and development of advanced level competencies that are needed for NAs.

CONCLUSION

Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. Hence, the change in prerequisites to the NA education program must be followed by evaluations of consequences on students' academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout.

Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study

BACKGROUND

Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time.

OBJECTIVE

To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics.

METHODS

This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (<90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with >3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days.

RESULTS

In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively).

CONCLUSIONS

Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality.

Exploring the alignment between paramedicine's professional capabilities and competency frameworks for current and evolving scopes of practice: a literature review

BACKGROUND

To adequately prepare graduates for the dynamic demands of paramedic practice, adopting a contemporary educational approach is essential. This involves collaborating to identify crucial competencies through input from industry stakeholders, experienced practitioners, and discipline-specific experts. Accreditation assumes a central role within this framework, serving as a cornerstone to ensure that paramedicine curricula align with paramedics' diverse and evolving professional roles.

METHODS

A narrative review of the literature and a directed search of grey literature were performed to identify specific developments in paramedicine competencies and scope of practice and mapped to the professional capabilities published by the Paramedicine Board of Australia. In determining a competency map and accreditation's role in a competency framework specific to current and evolving paramedic practice, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents, countries and other professions.

RESULTS

The review process identified 278 themes that were further allocated to 22 major analytical groupings. These groupings could further be mapped to previously reported cognitive, technical, integrative, context, relationship, affective/moral competencies and habits of mind. At the same time, the highest-rated groupings were key competencies of intellectual skills, safety, accountability, clinical decision-making, professionalism, communications, team-based approach and situational awareness. Two groups were represented in the literature but not in the professional capabilities, namely Health and Social continuum and self-directed practice.

CONCLUSIONS

This review highlights the importance of measuring and validating the professional capabilities of Paramedicine Practitioners. The study explores various metrics and competency frameworks used to assess competency, comparing them against national accreditation schemes' professional capability standards. The findings suggest that accreditation frameworks play a crucial role in improving the quality of paramedicine practice, encompassing intellectual skills, safety, accountability, clinical decision-making, professionalism, communication, teamwork, and situational awareness.

Determining Clinical Judgment Among Emergency Nurses During a Complex Simulation

INTRODUCTION

Clinical judgment is imperative for the emergency nurse caring for the acutely ill patients often seen in the emergency department. Without optimal clinical judgment in the emergency department, patients are at risk of medical errors and a failure to rescue.

METHODS

A descriptive observational approach using the Lasater Clinical Judgment Rubric evaluated nurses during a task that required recognition of clinical signs of deterioration and appropriate clinical care for simulated patients.

RESULTS

A total of 18 practicing emergency nurses completed only 44.6% of the patient assessments leading to low levels of clinical judgment throughout the simulation. Nurses expressed 4 levels of clinical judgment: exemplary (n = 1), accomplishing (n = 6), developing (n = 9), and beginning (n = 2). On average, nurses completed 69% of required tasks.

DISCUSSION

Assessments were completed less than half the time, demonstrating a breakdown in the noticing phase of clinical judgment. The nurses shifted to task completion focus with minimal use of clinical judgment. As the nurses remained task oriented, several medication and medical errors were noted while caring for the simulated patients. Experience and education did not influence observed clinical judgment among the participants. Given the extreme demands placed on the emergency nurse, it cannot be assumed that nurses have developed or can use clinical judgment when caring for their patients. Time and training targeting clinical judgment are essential for emergency nurse development.

Are They the Same for All People? Nurses' Knowledge about the Basic Human Needs of People with Disabilities

Nursing care involves a continuous interaction between nurses and people with disabilities. This has created a need for assessment tools that measure nurses' knowledge about the basic human needs of people with disabilities. The aim of this cross-sectional study was to develop a Knowledge of Basic Human Needs Scale and investigate nurses' levels of knowledge about the basic human needs of people with disabilities and their association with nurses' education. Data were analyzed using principal component analysis to test the construct validity and to identify factors using principal varimax rotation. The reliability estimate was based on Cronbach's alpha coefficient. Linear regression models were used to assess the association between knowledge about basic human needs and predictors. Factor analysis extracted eight factors, explaining 66.3% of the total variance. The sampling adequacy, criterion validity, and internal consistency were satisfactory. The nurses' levels of education was associated with their knowledge about the basic human needs of people with disabilities. The questionnaire constitutes a valuable contribution to improving nurses' knowledge and practice, as well as the quality of healthcare, and it provides a contribution to improving the quality of life for people with disabilities.

Call to Action: Creating Resources for Radiology Technologists to Capture Higher Quality Portable Chest X-rays

Background Patient rotation, foreign body overlying anatomy, and anatomy out of field of view can have detrimental impacts on the diagnostic quality of portable chest x-rays (PCXRs), especially as the number of PCXR imaging increases due to the coronavirus disease 2019 (COVID-19) pandemic. Although preventable, these "quality failures" are common and may lead to interpretative and diagnostic errors for the radiologist. Aims In this study, we present a baseline quality failure rate of PCXR imaging as observed at our institution. We also conduct a focus group highlighting the key issues that lead to the problematic images and discuss potential interventions targeting technologists that can be implemented to address imaging quality failure rate. Materials and methods A total of 500 PCXRs for adult patients admitted to a large university hospital between July 12, 2021, and July 25, 2021, were obtained for evaluation of quality. The PCXRs were evaluated by radiology residents for failures in technical image quality. The images were categorized into various metrics including the degree of rotation and obstruction of anatomical structures. After collecting the data, a focus group involving six managers of the technologist department at our university hospital was conducted to further illuminate the key barriers to quality PCXRs faced at our institution.. Results  Out of the 500 PCXRs evaluated, 231 were problematic (46.2%). 43.5% of the problematic films with a repeat PCXR within one week showed that there was a technical problem impacting the ability to detect pathology. Most problematic films also occurred during the night shift (48%). Key issues that lead to poor image quality included improper patient positioning, foreign objects covering anatomy, and variances in technologists' training. Three interventions were proposed to optimize technologist performance that can lower quality failure rates of PCXRs. These include a longitudinal educational curriculum involving didactic sessions, adding nursing support to assist technologists, and adding an extra layer of verification by internal medicine residents before sending the films to the radiologist. The rationale for these interventions is discussed in detail so that a modified version can be implemented in other hospital systems.  Conclusion This study illustrates the high baseline error rate in image quality of PCXRs at our institution and demonstrates the need to improve on image quality. Poor image quality negatively impacts the interpretive accuracy of radiologists and therefore leads to wrong diagnoses. Increasing educational resources and support for technologists can lead to higher image quality and radiologist accuracy.

Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction

Objective. The aim of this study is to examine the application value of systematic nursing interventions combined with continuity of care in cases with a spinal fracture complicated with a spinal cord injury and its effect on recovery and satisfaction. Methods. We identified ninety cases with a spinal fracture complicated with a spinal cord injury who were admitted to local hospital from May 2019 to May 2021 as research subjects and assigned them into an experimental group (systematic nursing combined with continuity of care, n = 45) and a control group (conventional nursing, n = 45) according to their admission order. The level of life of all groups between intervention was evaluated with reference to the Generic Quality of Life Inventory-74 (GQOLI-74) Rating Scale. The Hospital Anxiety and Depression (HAD) scale was used to assess the emotional status of patients before and after intervention. The complication rates, nursing outcomes, nursing satisfaction, and rehabilitation outcomes of all cases were calculated. Results. The GQOLI-74 score of the experimental group was higher than that of another group ( $P<0.05$ ). Lower HAD scores of experimental group were observed than that of another group ( $P<0.05$ ). The experimental group obtained remarkably higher nursing effective rates and higher nursing satisfaction than another group ( $P<0.05$ ). Rehabilitation outcome of the experimental group outperformed that another group ( $P<0.05$ ). Conclusion. The use of systematic nursing intervention combined with continuity of care for cases with spinal fracture complicated with a spinal cord injury can enhance the nursing effect, effectively relieve cases’ psychological pressure, improve patients’ level of life and nursing satisfaction, and contribute to the maintenance of a good nurse-patient relationship, which merits clinical promotion.

"Spanish Palliative Care Nurses' Degree of Acceptance of a Proposal for Nursing Competencies in Palliative Care"

Background: In Spain, palliative care (PC) nursing is not a recognized specialization and PC nurses do not receive systematic specialized academic training in PC. To ensure the quality of PC in Spain, the Spanish Association of Palliative Care Nursing has been working since 2011 to design a model of competencies for PC nurses. Objective: Verify whether a sample of Spanish PC nurses accepts the proposed model of PC nursing competencies describing their work. Methods: Descriptive cross-sectional observational study based on an ad-hoc questionnaire about 98 proposed competencies, which participants rated for whether they belong to the purview of PC nurses and for their degree of concordance with their own practice and their degree of importance in PC nursing. Competencies receiving approval by more than 75% of participants for the three dimensions were considered to have been accepted by consensus. Mixed logistical models were developed to study the association between demographic variables and the responses. Results: Sixty-two out of 98 proposed competencies were accepted by more than 75% of participants. We therefore considered these competencies to have been accepted by consensus. Thirty-six proposed competencies failed to meet the threshold of 75% acceptance. For competencies that were accepted overall, participants with more than 10 years of experience in PC and participants with specialized training in PC were more likely to report that these competencies were part of the purview of PC nursing. Participants age >50 were less likely to report that competencies related to research concorded with their practice. Participants accepted the importance of all 98 proposed competencies. Conclusion: The variables of experience, training and age had a statistically significant relationship with the acceptance or rejection of the proposed competencies on the basis of purview and concordance. Further research is necessary to understand more fully these relationships to eventually arrive at a consensus model for the competencies of PC nurses.

Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations

BACKGROUND

Health economic evaluations of the implementation of evidence-based interventions (EBIs) into practice provide vital information but are rarely conducted. We evaluated the health economic impact associated with implementation and intervention of the INTERCARE model-an EBI to reduce hospitalisations of nursing home (NH) residents-compared to usual NH care.

METHODS

The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective.

RESULTS

Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate.

CONCLUSIONS

As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness.

TRIAL REGISTRATION

clinicaltrials.gov ( NCT03590470 ).

A comparison of treatment signatures of high and low performing physical therapists for patients with lower back pain: analysis of spine care from a physical therapy outcomes registry

INTRODUCTION

Lower back pain (LBP) is the most common orthopedic complaint in the United States. Physical therapy is recommended as a conservative, non-pharmacological intervention for LBP. While it is thought that skill level and effectiveness of physical therapists differ, there is little understanding regarding characteristics that distinguish high and low performing physical therapists. The purpose of this study was to compare differences in care delivery, termed treatment signatures, between high and low performing physical therapists previously differentiated by a risk-adjusted performance measure.

METHODS

Using previously published methodology, 1,240 physical therapists were classified as "outperforming", "meeting expectations", or "underperforming" relative to predicted change in Modified Low Back Pain Disability Questionnaire (MDQ) across patients receiving care for LBP. Patients were divided into quartiles of baseline disability per initial MDQ. Two-way analyses of variance were used to compare billed (1) active, exercise-based units per visit (UPV), (2) manual therapy UPV, (3) modality UPV, and (4) the combination of active and manual therapy UPV (broadly termed skilled UPV) by performance cohort and baseline patient disability quartile among physical therapists deemed "outperforming" and "underperforming". Tukey's post hoc tests established mean differences with 95% confidence intervals.

RESULTS

Physical therapists that "outperformed" (n=120; 17,404 patients) used more active UPV (mean difference (diff) = 0.1, p<.001), manual therapy UPV (mean diff = 0.2, p<.001), and skilled UPV (mean diff = 0.3, p<.001), and less modality UPV (mean diff = 0.1, P < 0.001) than those that "underperformed" (n=139; 21,800 patients). Tukey's post hoc tests showed that while differences in care were negligible in patients with low baseline disability, the highest performing PT cohort delivered skilled (0.4 UPV), active (0.2 UPV), and manual therapy (0.2 UPV) UPV at a significantly higher mean rate in patients with the highest baseline disability.

CONCLUSIONS

Clinically effective physical therapists incorporated a treatment signature that included a consistent blend of skilled active and manual therapy interventions that was distinct from lower performing physical therapists. While group mean differences were relatively small, a consistent pattern emerged in which high performing physical therapists maintained a high level of skilled, one-on-one interventions across their entire caseload-while their lower performing counterparts significantly decreased use of the same interventions as baseline disability increased. These differences highlighted a treatment signature that was associated with clinically important improvements for patients with greater baseline disability. Future guideline recommendations should consider the importance of baseline disability and the consistent application of skilled active and manual therapy interventions.

Experiences of nurse managers and practitioners on implementation of an evidence-based practice intervention

Background

An evidence based practice (EBP) research project was undertaken to implement EBP interventions utilising the Iowa model in order to build the capacity of the nurses in using research evidence to improve decision making and quality care.

Aim

Exploring and understanding the experiences of nurse managers and practitioners who participated in the EBP change project.

Setting

The study was conducted in the intensive care unit (ICU) of a tertiary hospital in Lilongwe district in Malawi.

Methods

A qualitative approach and an exploratory-descriptive design was employed. The ICU was purposively selected as a unit where the EBP change project was implemented. A purposive sample of 10 nurse managers and practitioners was selected. Semi-structured interviews were conducted. All interviews were audio-recorded with a digital recorder and transcribed verbatim. Thematic analysis was applied to the transcripts.

Results

The participants’ experiences of implementing EBP interventions were underpinned by four themes namely, evidence-based patient management, effective nursing care, competence in delivering EBP, and factors interplaying in EBP. Use of model, protocol and availability of supportive managers and team were major determinants of EBP.

Conclusion

It is recommended to continue utilising the Iowa Model to facilitate building the EBP capacities of providers during scale up.

Contribution

Utilising the Iowa Model facilitates building of the capacity and empowers frontline nurses to effectively develop, implement and evaluate discipline specific EBP changes needed to improve practice and optimum care.

The importance of interdisciplinarity in accommodating patient needs among norwegian nurses

WHAT IS KNOWN ON THE SUBJECT

Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors. Mental health nurses often describe role confusion in relation to other health professionals. Opportunities for interdisciplinary communication with other professionals may benefit health care.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

The current large-scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities. Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so.

WHAT ARE THE IMPLICATIONS OF PRACTICE

The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needs Interdisciplinary teamwork could strengthen nurses' ability to address patient needs Finding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met.

ABSTRACT

INTRODUCTION: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors.

AIM/QUESTION

The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs.

METHOD

A cross-sectional web-based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded.

RESULTS

The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs.

DISCUSSION/IMPLICATION FOR PRACTICE

Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services.

Personal and professional influences on health visitors' family focused practice for maternal mental illness: a cross sectional study

BACKGROUND

Family focused practice (FFP) is an approach that recognises the inter-related needs of family members and recommends a continuum of activities to support families. While it is recognised that health visitors play a key role in supporting families when mothers have mental illness, there is limited understanding of health visitor's family focused practice (FFP) in this context and its relationships with factors, such as, workload, training, skill and knowledge, and personal and professional experience. This paper examined the effect of health visitors' interaction with the family, and personal and professional experience on their family focused practice.

METHODS

A cross sectional questionnaire (Family Focused Mental Health Practice Questionnaire) was distributed to 488 health visitors within community practice in Northern Ireland, with 230 choosing to take part. Independent t-tests and one-way analysis of variance were used to compare family focused practice scores.

RESULTS

Results found that health visitors who had face to face contact with partners and children (t(221) = 2.61, p = .01), and those that directly supported the partner (t(221) = 2.61, p = 0.01) had a significantly higher mean score of FFP, than those that did not. However, frequency of visits (daily, weekly, monthly or yearly) had no effect on family focused practice scores. Training also had a significant effect on family focused practice scores (F(2,221) = 4.841, p = 0.029). Analysis of variance revealed that personal experience of mental illness had a significant effect on scores (M = 97.58, p = 0.009), however variables such as, age, parental status, time since registration, and being in a specialist position had no effect.

CONCLUSIONS

In order for family focused practice to be effective, the quality, and content of visits and contact with family should be addressed, as opposed to a focus on the quantity of visits. However, in order for this to occur health visitors need to have appropriate support in their own right, with manageable caseloads and resources.

Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study

PURPOSE

This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi.

DESIGN AND METHODS

A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC.

RESULTS

The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, β = 9.162, p = 0.014), had a postgraduate qualification (β = 23.314, p < 0.001), were separated or widowed (β = 9.661, p = 0.029), had a Tumbuka cultural background (β = 12.984, p < 0.001), were Seventh-day Adventist members (β = 8.863, p = 0.026), and worked in mission hospitals (β = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (β = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (β = 6.625, p = 0.046), and were nurse midwife technicians (β = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary.

CONCLUSION

Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi.

PRACTICE IMPLICATIONS

Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.

Are emotional intelligence and compassion associated with nursing safety and quality care? A cross-sectional investigation in pediatric settings

PURPOSE

To assess and compare the perceptions of emotional intelligence, compassion, and safety and quality care held by parents of hospitalized children and nurses, and to examine the association between emotional intelligence, compassion, and safety and quality care among nurses.

DESIGN AND METHODS

This cross-sectional study comprised 80 parents whose children were hospitalized for at least three days, and 71 nurses who treated these children. The data were collected during April-June 2018 using a self-administered questionnaire addressing socio-demographic characteristics, safety and quality care in the ward, emotional intelligence, and compassion. A hierarchical multiple regression model was used to assess whether emotional intelligence and compassion could be associated with safety and quality care among pediatric nurses.

RESULTS

Parents considered the safety and quality care in the ward to be significantly (p = .003) higher (M = 4.23 ± 0.61) than did nurses (M = 3.97 ± 0.46). Compassion had a significant positive effect on safety and quality of care (β = 0.260; p = .041), while seniority in nursing had a significant negative effect on safety and quality care (β = -0.289;p = .021). Null effect was found between emotional intelligence and safety and quality care.

CONCLUSION

Compassionate care should be targeted to improve the safety and quality of nursing care delivered to children and their parents.

PRACTICE IMPLICATIONS

Nurse ward managers should promote procedures and guidelines concerning safety and quality care processes among older nurses. Specifically, we recommend nurse ward managers to leverage the results and dedicate efforts to continue to provide compassionate care in pediatric settings as an integral part of safety and quality care.

Nurses' Awareness and Actual Nursing Practice Situation of Stroke Care in Acute Stroke Units: A Japanese Cross-Sectional Web-Based Questionnaire Survey

The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading > 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients' physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses' competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice.

Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States

OBJECTIVE

The aim of the study was to investigate the association between hospitals' nursing excellence accreditation and patient safety performance-measured by the Hospital-Acquired Conditions Reduction Program (HACRP).

METHODS

We linked data from the American Nursing Credentialing Center Magnet Recognition Program, Centers for Medicare and Medicaid Services HACRP, and the American Hospital Association annual survey from 2014 to 2016. We constrained the analysis to hospitals participating in Centers for Medicare and Medicaid Services' HACRP and deployed propensity score matching models to calculate the coefficients for our HACRP patient safety measures. These measures consisted of (a) patient safety indicator 90, (b) hospital-associated infection measures, and (c) total HAC scores. In addition, we used propensity score matching to assess HACRP scores between hospitals achieving Magnet recognition in the past 2 versus longer and within the past 5 years versus longer.

RESULTS

Our primary findings indicate that Magnet hospitals have an increased likelihood of experiencing lower patient safety indicator 90 scores, higher catheter-associated urinary tract infection and surgical site infection scores, and no different total HAC scores. Finally, when examining the impact of Magnet tenure, our analysis revealed that there were no differences in Magnet tenure.

CONCLUSIONS

Results indicate that the processes, procedures, and educational aspects associated with Magnet recognition seem to provide important improvements associated with care that is controlled by nursing practice. However, because these improvements do not differ when comparing total HAC scores nor Magnet hospitals with different tenure, there are likely opportunities for Magnet hospitals to continue process improvements focused on HACRP scores.

Effectiveness of pediatric learning modules in enhancing competencies among nurses in a specialized unit

The global shortage of highly competent nurses has forced healthcare organizations to adapt to various strategies, including rotating nurses to different units, impacting their competency levels. To equip nurses with the needed competencies, the researchers developed the pediatric learning modules and conducted this study to analyze their effectiveness. Researchers employed purposive and random sampling to identify study participants, and utilized a mixed-method design, including Solomon Four Group Design and a narrative approach. A researcher-made evaluation questionnaire, competency checklists, and guide questions for a written narrative were used to collect data. Descriptive statistics and factorial analysis of covariance were utilized for data analysis. The outcomes revealed that demographic variables have no effect on knowledge and competence (p > 0.05). It was also discovered that exposure to learning modules enhanced the competence levels of nurses who were inexperienced in the pediatric setting (F = 41.183, df = 1, p = 0.000). Furthermore, results revealed that enhancing knowledge and competencies is not wholly dependent on well-structured educational sessions and training modules, but is also influenced by other factors, including time allocation for module delivery, protected time to practice, and the opportunity to apply new skills in the clinical area.

Do advanced clinical practitioners have the theoretical knowledge to authorise blood components for transfusion? A cross sectional survey Study

AIM

The aim of this study is to investigate whether non-medical authorisers of blood component transfusion, in a single centre working at an advanced level, have the theoretical knowledge to potentially undertake this task safely.

BACKGROUND

Authorisation of blood components for transfusion has predominantly been a medical role in the United Kingdom. Advanced Clinical Practitioners (ACP) are increasingly undertaking this role in order to maintain timely transfusion care.

DESIGN

A cross sectional study design was utilised for this study which was conducted between 05th March 2018 and the 4th of April 2018.

METHODS

A total of 81 participants (49 medical authorisers and 32 Advanced Clinical Practitioners of which 21 were nurses and 11 were Allied Healthcare Professionals) working in a single centre completed the BEST-TEST, a previously validated knowledge assessment tool (Transfusion, 54, 2014, 1225). This study's methods were compliant with the STROBE Checklist.

RESULTS

The overall mean was 8.74 out of a possible 20 questions. Doctors scored higher within the basic science domain compared to Advanced Clinical Practitioners (p = .01). This study found the method of training received by its participants was statistically significant with those receiving formal training scoring more than those who had received on the job training from their colleagues (p = .02). When all specialities were compared for differences with the mean correct scores a statistically significant difference was found (p = .01).

CONCLUSION

This study demonstrates there is no statistically significant difference in transfusion medicine knowledge between professional subgroups working in a single centre. Furthermore, there is deficits in the knowledge of all subgroups.

RELEVANCE TO CLINICAL PRACTICE

With advanced practice roles expanding, it is essential that we realise their full potential. There is no current research examining knowledge of ACPs, who could potentially authorise blood components for transfusion, but there are some clear benefits for clinical practice such as providing safe, timely and patient centred care.

The role of nurses in surveillance to enhance global health security: A delphi study

BACKGROUND

Internationally, nurses are gaining recognition for their contributions to public health and global health initiatives, however, their contributions to surveillance and the detection of new and emerging infectious disease, which is an important element of global health security, remain largely unknown.

PURPOSE

The purpose of this study was to investigate the perceptions of nurse experts related to the current and optimal roles of nurses in surveillance of new and emerging infectious diseases. Additionally, this study aimed to identify the skills needed by nurses in all practice settings for optimal performance of surveillance and to identify barriers to achieving optimal performance of surveillance.

METHODS

A three-round Delphi study was conducted. Nurse experts participated in Round 1 interviews followed by ranking current and optimal role, skill, and barrier statements in Rounds 2 and 3.

FINDINGS

Findings revealed four current roles and 13 optimal roles for nurses in surveillance, 13 skills needed to perform surveillance activities, and seven barriers to optimal performance of surveillance activities by nurses.

DISUCSSION

Results of this study are intended to inform nursing practice and education in the U.S., and to provide guidance on the role of nurses in surveillance of new and emerging infectious disease as part of the Global Health Security Agenda.

Capacity building of healthcare workers: Key step towards elimination of viral hepatitis in developing countries

BACKGROUND

Lack of awareness about viral hepatitis (VH) potentially predisposes the healthcare workers (HCWs) to a higher risk of infection and may in turn increase the risk of transmission of the infection to their families and in the community. Thus, combating VH, requires adequate and updated training to the HCWs. With this objective, Project PRAKASH designed a meticulously planned training program, aimed to assess the effect of a one-day training on VH among in-service nurses.

METHODS AND MATERIAL

The content and schedule of scientific sessions of the training program were decided by subject experts to improve knowledge, attitude and practice(KAP) related to VH among in-service nurses. A 54-item questionnaire divided into four domains: Transmission and Risk Factors; Prevention; Treatment; Pathophysiology and Disease Progression were used to assess the KAP related to VH. The questionnaire consisted of four sections: demographic details, knowledge(30-items), attitude(12-items) and practice(12-itmes) with a total score of 30, 60 and 24 respectively in each section. The pre-post knowledge assessment was done and impact assessment survey was undertaken among the participants who completed six months post-training period. Paired-t-test was used to assess the effect of training on knowledge using SPSSv-22.

RESULTS

A total of 5253 HCWs were trained through 32 one-day trainings, however data for 4474 HCWs was included in final pre-post knowledge analysis after removing the missing/incomplete data. Mean age of participants was 33.7±8.4 with median experience of 8(IQR: 3-13). Mean improvement in knowledge score was found to be significant (p<0.001) with mean knowledge score of 19.3±4.4 in pre-test and 25.7±3.9 in the post-test out of 30. Impact assessment survey suggested change in attitude and practice of HCWs.

CONCLUSION

The one-day training programs helped the in-service nurses to enhance their knowledge related to viral hepatitis. The study provided a roadmap to combating viral hepatitis through health education among HCWs about viral hepatitis.

The varied role, scope of practice, and education of cardiovascular nurses in ESC-affiliated countries: an ACNAP survey

AIMS

Cardiovascular disease burden is increasing globally, pressuring nursing staff to deliver high-quality care across a diverse range of treatment areas. As such, an evaluation of the educational preparation of nurses is needed. To determine the current role, scope of practice, education level, and needs of cardiovascular nurses working across the European Society of Cardiology (ESC)-affiliated countries.

METHODS AND RESULTS

A short survey was distributed in paper (EuroHeartCare 2018) or electronic format to nurses delivering cardiovascular care. A total of 876 cardiovascular nurses from 26 ESC-affiliated countries completed the survey. Most respondents (79%), were educated to at least bachelor level, with 46% having a masters or doctorate, and were highly motivated to continue their educational development. Despite this, a large number (44.3%) of respondents believed they were not fully prepared for their job. The main areas where further education was requested included acute care in cardiovascular disease (CVD) and CVD risk factor management. Face-to-face courses/training were the most requested delivery mode, followed by E-learning-which appears to be underutilized in this population. Awareness of the existing curricula for cardiovascular nurse education was minimal, and therefore these resources require further promotion and implementation.

CONCLUSIONS

This international sample of cardiovascular nurses was generally educated to degree level and motivated to improve their cardiovascular knowledge. Many believed they were underprepared for their role, highlighting the need for increased investment in education. This should be focused on specific needs and delivered using a face-to-face, E-learning, or blended-learning format. Furthermore, increased signposting of existing resources is required.

Predictors of physical restraint use on critical care units: An observational structural equation modeling approach

BACKGROUND

Modifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored.

OBJECTIVES

Our objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use.

DESIGN

The study was a secondary analysis of 2017-2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data.

METHODS

Work environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score.

RESULTS

The sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0-53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010-0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = -0.088, 95% confidence -0.178- -0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = -0.114, 95% confidence interval -0.222--0.025) and higher order models (β = -0.117, 95% confidence interval -0.223- -0.012).

CONCLUSION

We found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.

Exploring the relation between modelled and perceived workload of nurses and related job demands, job resources and personal resources; a longitudinal study

Aim

Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, job resources and personal resources on the relation.

Design

Academic hospital in the Netherlands. Six surgical wards, capacity 15–30 beds. Data collected over 15 consecutive day shifts.

Methods

Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards.

Results

Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload.

Conclusions

The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.

Factors supporting career pathway development amongst advanced practice nurses in Thailand: A cross-sectional survey

BACKGROUND

Thailand has recently reformed its health care system and this change has contributed to the rapidly increasing need for skilled and experienced specialist nurses and in 2003 a new Advanced Practice Nursing role was formally introduced. While Advanced Practice Nursing is now accepted as a clinical career option, there is little understanding of the factors conducive to successful career development. This study offers the first examination of factors associated with successful career progression for Advanced Practice Nurses in Thailand.

OBJECTIVES

1. To provide a description of the Advanced Practice Nurse population in Thailand, as represented by a purposive stratified national sample. 2. To examine the factors influencing successful career pathway development of Advanced Practice Nurses in Thailand. 3. To examine the factors which influence the extent to which Advanced Practice Nurses in Thailand engage in evidence-based practice and research.

DESIGN

National cross-sectional survey.

SETTING

Thailand.

PARTICIPANTS

333 currently practicing Advanced Practice Nurses.

METHODS

A national cross-sectional survey was conducted in Thailand in order to identify and examine key influencing factors on the successful development of Advanced Practice Nurses. The research tool was a specifically designed questionnaire in the Thai language, informed by international academic literature on the development of the Advanced Practice Nurse role, validated and piloted with 30 Advanced Practice Nurses to assess its reliability using Cronbach's alpha. The data were analysed in SPSS (version 21). Initial parametric testing was done using the Kolmogorov-Smirnov test and Pearson's correlation analysis was performed to examine the relationship between the independent variables (those measuring demographic and support factors) and the dependent variables (measuring career pathway development).

RESULTS

A response rate of 90% was achieved. A lack of clear progression routes in the Advanced Practice Nurse structure was identified along with inconsistent patterns of working including variation in the number of days per week (range: 1-5 days) that nurses dedicated to the Advanced Practice Nurse role and the amount of autonomy achieved in this role. The study highlighted a lack of research productivity in and production of outputs (59% had never published) and given the expectation of Advanced Practice Nurses to both produce and utilise research evidence, this constitutes a significant gap in current practice. Other factors reported as important for career pathway development of Advanced Practice Nurses related to the environment, peer networks, institutional (hospitals) and external (government and the Thai Nursing Council) support.

CONCLUSIONS

Our study offers insights for national and local policymakers and highlights the need to firmly establish, standardised career pathways in Advanced Practice Nursing to support career progression and the implementation of evidence into practice. These findings also have implications for clinical departments which have a responsibility to ensure they provide an enabling environment for Advanced Practice Nurses to fully carry out their roles. Tweetable abstract: Our study reports findings from a first national survey in Thailand investigating the factors which support career development in Advanced Practice Nurses.

Nursing Skills Video Selfies: An Innovative Teaching and Learning Strategy for Undergraduate Nursing Students to Master Psychomotor Skills

Introduction

The quality of care for patients is linked to the performance and competence of nurses. Nurse educators are challenged to prepare graduates to deliver safe, competent, patient-centered care. Nursing skills video "selfie" is an innovative teaching and learning strategy in which nursing students use technology to create videos of themselves (video selfie) performing psychomotor skills.

Method

The instructional exercise of creating the video selfie was administered to a group of nursing students in a medical-surgical class. The laboratory instructors identified three psychomotor nursing skills. In the skills lab, the instructors showed videos to demonstrate how the skills were performed. The students returned demonstration in the lab and were asked to return to the lab independently to practice the skills and to create a video selfie.

Results

The exercise encouraged students to increase the quality and length of practice and master the skill. Students demonstrated confidence to perform the skills and to accurately list each step required to perform the skills. The video selfie was used as a peer evaluation tool and as a faculty assessment tool to guide individual students' instruction, learning, and remediation.

Conclusion

The exercise had some shortcomings. Future quantitative research using survey instruments to collect data from a larger group of nursing students is needed to validate the utility of this innovative teaching and learning strategy in nursing programs.

Level of clinical reasoning in intermediate nursing students explained by education year and days of internships per healthcare branches: A cross - sectional study

BACKGROUND

Due to changes in health care nurses are achieving more responsibilities. Globally nurses are trained at different educational levels to become registered nurses. All nurses should be able to implement clinical reasoning in chronic and acute patient care. There is uncertainty in health care institutes about the level of performance of clinical reasoning in the intermediate nurses.

OBJECTIVES

This cross-sectional study aimed to assess the level of clinical reasoning in intermediate nursing students in different education years. Furthermore, we explored whether the level of clinical reasoning can be explained by years of education and numbers of internship days in different healthcare settings.

DESIGN, SETTING AND PARTICIPANTS

All second, third and fourth year (n = 151) nursing students of one nursing school in the Netherlands were invited to participate in this study. Levels of clinical reasoning were assessed using the Dutch Lasater Clinical Judgment Rubric (D - LCJR).

METHODS

Twelve experienced nurses assessed the students during two days at the beginning of their education year in an educational simulation setting. Following the assessment protocol, the Rubric was scored in an interview after the students saw their patient.

RESULTS

We assessed 119 students. Fourth-year students scored on a significant higher level of clinical reasoning compared to the second - and third-year students (p < 0.001). Forty five percent of them reached an accomplished level of clinical reasoning. Second- and third-year students scored similar in their level of clinical reasoning (p = 0.61). In addition to education year an internship in the hospital care also explained the variation in level of clinical reasoning. Together they explained 38% (p < 0.001).

CONCLUSIONS

Intermediate nursing students were successfully assessed on their level of clinical reasoning in an education environment. The level of clinical reasoning could be explained by education year and number of days internship in the hospital care.

The Nurse as an Information Broker for Children with Terminal Illness: A Qualitative Study

Background:

Providing care for children with a terminal illness is a great challenge for nurses and might be very complex. Several roles can be performed while providing nursing care.

Objective:

The aim of this study was to identify the roles of nurses in providing nursing care to children with terminal illness and explore the nurse's perspective on how they perform their role in caring for children with terminal illness.

Methods:

This research was conducted qualitatively with a content analysis approach. In-depth interviews with 8 nurses and focus group discussion with 7 nurses were the data collection methods used in this study. The sampling technique in this research is purposive sampling with inclusion criteria for nurses who were willing to participate in this research with a minimum education of diploma degree in nursing, and having at least 3 years of working experience in the pediatric ward.

Results:

Based on the nurses’ perspectives, their role as a communicator, counselor, collaborator, advocator, educator, and also as care provider make them an information broker for children with terminal illnesses and their families.

Conclusion:

In conclusion, while performing the roles, nurses must have good communication skills and knowledge related to the condition of the child as well as the ability to work with other healthcare teams with the purpose of providing holistic and comprehensive care for children with a terminal illness.

A Theoretical Framework to Underpin Clinical Learning for Undergraduate Nursing Students

The aim of this is paper is to propose Benner's "Novice to Expert" Framework to underpin learning for students as they progress through the clinical components of an undergraduate nursing educational program. Steinaker and Bell's "Experiential Taxonomy" is presented as a practical medium for itemizing the nursing activities novices are exposed to at the initiation of clinical experience and to the clinical competencies expected of nurses on completion of their educational program. The authors also propose a range of theories of learning applicable to the clinical education of undergraduate nursing students, which can be maximized to enhance clinical learning.

Sternal Precautions and Prone Positioning of Infants Following Median Sternotomy: A Nationwide Survey

PURPOSE

To describe current practice of pediatric sternal precautions (PSPs) and prone positioning restrictions (PPRs) in infants after median sternotomy.

METHODS

A Web-based survey with 21 questions was developed on the basis of a review of current literature and expert consultation. Snowball sampling resulted in 68 participants well represented by profession throughout the United States.

RESULTS

Approximately 80% of participants reported having institutional protocols for PSPs. Most common reported PSPs were no lifting at the axillae and no pulling of arms to achieve sitting. PSPs also included PPRs. The opinions of participants supported no PPRs or modified PPRs compared with strict PPRs.

CONCLUSIONS

Types of PPRs varied across participants, with the majority of participants in favor of modified PPRs while PSPs were less varied. Research is needed to examine the effects of PSPs and PPRs in infants post-median sternotomy.

The effectiveness of educational interventions on trauma intensive care unit nurses' competence: A systematic review and meta-analysis

OBJECTIVES

To examine the current evidence on the effect of education on intensive care unit nurses' knowledge and skills competence in caring for adult major trauma patients.

METHODOLOGY

A systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality.

RESULTS

Five eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses' knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29-47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84-38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up.

CONCLUSION

This review demonstrated the significant effects of trauma education on improving intensive care nurses' knowledge and practices. Further research should develop valid competencies and policies to drive nurses' practice and potentially improve the safety and quality of care.

The Relationship Among Secondary Trauma, Self-Efficacy, and Correctional Nurses

Many of the nurses working in corrections suffer from secondary trauma as a result of taking care of a population that has had a high percentage of traumas in their lives. There is limited research in correctional nursing, and perhaps by identifying the relationship among secondary trauma, self-efficacy, and correctional nursing, there will be growth as a profession. A literature review was completed using PubMed, CIHAHL, and Google Scholar. If nurses apply self-efficacy and secondary traumatic growth into their profession, they will be removing negative emotions from secondary trauma and emergency medical crisis situations. With the correctional populations, it is important for correctional nurses to recognize the barriers in themselves to better take care of their patients. This might then lead to better care and have an impact on the violence in society upon release.

Developing and psychometric testing of the anaesthesia nursing competence scale

RATIONALE, AIMS, AND OBJECTIVES

The competence of nurses in anaesthesia care is important for the quality of anaesthesia nursing care and patient safety. However, there is a lack of psychometrically tested instruments to measure the competence. Therefore, this study aimed to develop and test the psychometric properties of an anaesthesia nursing competence scale (AnestComp) assessing nurses' competence in anaesthesia care.

METHOD

The scale development and psychometric testing had three phases: (1) based on literature reviews and the description of experts, competence areas were identified and items were created; (2) the content validity of the scale was tested by a content expert group, and the scale was pilot tested; and (3) psychometric testing of scale was tested by anaesthesia nurses' (n = 222) and nursing students' (n = 205) self-assessments. The psychometric testing assessed the reliability when using Cronbach's α and the construct validity using factor analyses (confirmatory and exploratory) and known-group technique. Nursing students were included for the purpose of construct validity testing.

RESULTS

The AnestComp has 39 items and consists of seven competence areas: (a) ethics of anaesthesia care, (b) patient's risk care, (c) patient engagement with technology, (d) collaboration within patient care, (e) anaesthesia patient care with medication, (f) peri-anaesthesia nursing intervention, and (g) knowledge of anaesthesia patient care. Cronbach's α values were high in all categories (0.83-0.95), and factor analyses and known-group technique supported a seven-factor model.

CONCLUSION

The initial results supported the reliability and construct validity of the AnestComp. The scale is considered a promising instrument for measuring anaesthesia nursing competence among anaesthesia nurses. Further research with larger and more diverse samples is suggested to refine the current psychometric evaluation.

"Science and proven experience": How should the epistemology of medicine inform the regulation of healthcare?

The Swedish medico-legal concept of "science and proven experience" is both legally important and ambiguous. The conceptual uncertainty associated with it can hamper effective assessment of medical evidence in legal proceedings and encourage medical professionals to distrust legal regulation. We examine normative criteria a functioning medico-legal notion should presumably meet, e.g. clarity, acceptability and consistency with existing laws. We also survey healthcare professionals to see how they understand science and proven experience and thus determine the extent to which their understanding meets the normative criteria. The survey suggests that medical professionals feel more certain about "science and proven experience" in the medical context than they do in a legal context. They still have substantial trust in the legal use of the notion, but they do not believe that legal professionals should be allowed to determine the meaning of "science and proven experience" in the legal context. With these results in mind, we argue that the best way to meet the normative criteria and resolve conceptual uncertainty is to specify sub-questions that clarify the notion. We recommend an analytical-deliberative approach that will close the gap between the medical and legal professions' perceptions of how law and medicine relate.

Nurses' Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

Background

Physical restraint is a common practice in the intensive care units which often result in frequent skin laceration at restraint site, limb edema, restricted circulation, and worsening of agitation that may even end in death. Despite the sensitivity of the problem, however, it is felt that there are nurses' evidence-based practice gaps in Ethiopia. To emphasize the importance of this subject, relevant evidence is required to develop protocols and to raise evidence-based practices of health professionals. So, this study aimed to assess the knowledge, attitude, and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia.

Methods

An institution-based cross-sectional study was maintained from March to September 2019 at Amhara regional state referral hospitals, northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff regarding Physical Restraints Questionnaire was used to assess the nurses' knowledge and attitude. Linear regression analysis was employed to examine the influencing factors of knowledge and attitude. Adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association with a p value < 0.05 statistical significance level.

Result

The mean scores of nurses' knowledge and attitude regarding physical restraint use among critically ill patients were 7.81 ± 1.89 and 33.75 ± 6.50, respectively. These mean scores are above the scale midpoint nearer to the higher ranges which imply a moderate level of knowledge and a good attitude regarding physical restraint. Lower academic qualification and short (<2 years) work experience were associated with lower-level of knowledge, and reading about restraint from any source and taken training regarding restraints were factors associated with a higher knowledge. Diploma and bachelor's in academic qualification were significantly associated with a negative attitude regarding restraint. Besides, there was a more positive attitude among nurses with a higher level of knowledge and who received training regarding physical restraint use.

Conclusion

The nurses working in the intensive care unit had a moderate level of knowledge and a good attitude regarding physical restraint use. So, developing and providing educational and in-service training to the nurses regarding physical restraint are necessary to strengthen the quality of care for critically ill patients.

"I train and mentor, they take them": A qualitative study of nurses' perspectives of neonatal nursing expertise and its development in Kenyan hospitals

Aims and Objectives

Neonatal inpatient care is reliant on experienced nursing care, yet little is known about how Kenyan hospitals foster the development of newborn nursing experience in newborn units.

Design

A Qualitative ethnographic design.

Methods

Face to face 29 in depth interviews were conducted with nurses providing neonatal care in one private, one faith based and one public hospital in Nairobi, Kenya between January 2017 and March 2018. All data were transcribed verbatim, coded in the original language and analysed using a framework approach.

Results

Across the sectors, nurses perceived experience as important to the provision of quality care. They noted that hospitals could foster experience through recruitment, orientation, continuous learning and retention. However, while the private hospital facilitated experience building the public and faith-based hospitals experienced challenges due to human resource management practices and nursing shortages.

Conclusion

Health sector context influenced how experience was developed among nurses.

Implications

Nurturing experience will require that different health sectors adopt better recruitment for people interested in NBU work, better orientation and fewer rotations even without specialist nurse training.

A survey on the training needs of caregivers in five European countries

AIM

This survey explored caregivers' perceived training needs in 5 European countries (United Kingdom, Greece, Bulgaria, Poland and Italy).

BACKGROUND

Training can enhance the professional capacity of caregivers; however, caregivers' training needs within Europe have not been examined recently.

METHODS

A survey conducted in 2015 captured data from 550 caregivers using a convenience sampling strategy, through a structured questionnaire and additional open-ended items and by conducting statistical and content analysis.

RESULTS

The results indicated basic nursing skills and specialization, as well as training in psychology-related skills like time management, emotion regulation, communication and advanced health care systems as the emerging training needs. There were some country differences in specific training need areas.

CONCLUSIONS

It was concluded that training in basic nursing skills and specialization in nursing specific conditions, in advanced health care systems and in psychology-related skills could add to the professional capacity of European caregivers employed in health and social care.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings inform about employed caregivers' training needs in Europe, which may contribute in the provision of quality care and organisational efficiency in health and social care.

Healthcare professionals' perspective can guide post-marketing surveillance of artemisinin-based combination therapy in Uganda

BACKGROUND

Efficient testing to identify poor quality artemisinin-based combination therapy (ACT) is important to optimize efforts to control and eliminate malaria. Healthcare professionals interact with both ACT and malaria patients they treat and hence could observe, first-hand, suspect poor quality artemisinin-based combinations linked to poor malaria treatment outcomes and the factors associated with inappropriate use or treatment failure.

METHODS

A cross-sectional study of 685 HCP perspectives about the efficacy of ACT between June and July 2018 at selected health facilities in Uganda. Medicine samples were obtained from the seven regions of Uganda and tested for quality using the Germany Pharma Health Fund™ minilabs.

RESULTS

The average age of the 685 respondents was 30 (SD = 7.4) years. There was an almost equal distribution between male and female respondents (51:49), respectively. Seventy percent (n = 480) were diploma holders and the nurses contributed to half (49%, n = 334) of the study population. Sixty-one percent of the HCPs reported having ever encountered ACT failures while treating uncomplicated malaria. Nineteen percent of HCPs thought that dihydroartemisinin/piperaquine gave the most satisfactory patient treatment outcomes, while 80% HCPs thought that artemether/lumefantrine gave the least satisfactory patient treatment outcomes, possibly due to dosing schedule and pill burden. Healthcare professionals from the Central region (OR = 3.0, CI 0.3-1.0; P = 0.0001), Eastern region (OR = 5.4, CI 2.9-9.8; P = 0.0001) and Northern region (OR = 5.3, CI 2.9-9.9; P = 0.0001) had a higher chance of encountering ACT failure in 4 weeks prior to the survey as compared to those from the western region. Healthcare professionals from private health facilities also had higher chances of encountering ACT failures in past 4 weeks as compared to those from public health facilities (OR = 2.7, CI 1.7-3.9; P = 0.0001). All 192 samples passed the quality screening tests. The random sample of 10% of all samples randomly obtained by the laboratory staff also passed the chemical content analysis and dissolution tests.

CONCLUSION

ACT medicines are widely available over-the-counter to the public and it is very difficult to report and monitor a decrease in efficacy or treatment failure. The perspectives of HCPs on treatment failure or lack of efficacy may potentially guide optimization efforts of sampling methodologies for the quality survey of ACT medicines.

Expertise among critical care nurses: A grounded theory study

OBJECTIVES

Explore critical care nurses' personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice.

DESIGN

Following constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process.

SETTING

A multi-site urban area in the southeastern United States.

PARTICIPANTS

10 certified critical care nurses, three males and seven females, with 10-30+ years of critical care experience.

FINDINGS

Experience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses' aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care.

CONCLUSION

Key findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse's trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.

"How do we use the time?" - an observational study measuring the task time distribution of nurses in psychiatric care

Background

The nurse’s primary task in psychiatric care should be to plan for the patient’s care in cooperation with the patient and spend the time needed to build a relationship. Psychiatric care nurses however claim that they lack the necessary time to communicate with patients. To investigate the validity of such claims, this time-motion study aimed at identifying how nurses working at inpatient psychiatric wards distribute their time between a variety of tasks during a working day.

Methods

During the period of December 2015 and February 2016, a total of 129 h and 23 min of structured observations of 12 nurses were carried out at six inpatient wards at one psychiatric clinic in southern Sweden. Time, frequency of tasks and number of interruptions were recorded and analysed using descriptive statistics.

Results

Administering drugs or medications accounted for the largest part of the measured time (17.5%) followed by indirect care (16%). Relatively little time was spent on direct care, the third largest category in the study (15.3%), while an unexpectedly high proportion of time (11.3%) was spent on ward related tasks. Nurses were also interrupted in 75% of all medication administering tasks.

Conclusions

Nurses working in inpatient psychiatric care spend little time in direct contact with the patients and medication administration is interrupted very often. As a result, it is difficult to establish therapeutic relationships with patients. This is an area of concern for both patient safety and nurses’ job satisfaction.