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Rietze LL, Stajduhar KI, Purkis ME, Cloutier D. The Challenges of Advance Care Planning for Acute Care Registered Nurses. Can J Nurs Res 2024; 56:293-302. [PMID: 38576275 PMCID: PMC11308282 DOI: 10.1177/08445621241244532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
STUDY BACKGROUND The practice of acute care nurses is shaped by organizational factors such as lack of privacy, heavy workloads, unclear roles, lack of time, and lack of specific policies and procedures. We know little about the social and organizational structures and processes that influence nurses' uptake of valuable patient-centered discussions like advance care planning (ACP). ACP is beneficial for patients, their substitute decision makers, and healthcare providers. PURPOSE To describe the operational, organizational, and societal influences shaping nurses' ACP work in acute care settings. METHODS This ethnographic study purposively sampled 14 registered nurses and 9 administrators who worked in two acute care hospitals in Northeastern Ontario. Methods consisted of 23 open-ended, semi-structured interviews, 20 hours of observational fieldwork, and a collection of publicly available organizational documents. Data were inductively analyzed using an iterative constant comparative approach. RESULTS Nurses were challenged to meet multiple competing demands, leaving them to scramble to manage complex and critically ill acute care patients while also fulfilling organizational tasks aligned with funding metrics, accreditation, and strategic planning priorities. Such factors limited nurses' capacity to engage their patients in ACP. CONCLUSIONS Acute care settings that align patient values and medical treatment need to foster ACP practices by revising organizational policies and processes to support this outcome, analyzing the tasks of healthcare providers to determine who might best address it, and budgeting how to support it with additional resources.
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Affiliation(s)
- Lori L. Rietze
- School of Nursing, Laurentian University, Sudbury, ON, Canada
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Grande RAN, Berdida DJE, Cornejo LTO, Villagracia HN, Al-Shammari MK, Alshammari AT, Alenezi HS, Alshammari TA. Psychometric testing of the nurse professional competence scale Arabic version: An exploratory and confirmatory factor analyses. Nurse Educ Pract 2023; 70:103679. [PMID: 37331029 DOI: 10.1016/j.nepr.2023.103679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
AIM To translate the Nurse Professional Competence Scale-Short Form English version into Arabic and psychometrically validate its properties among Saudi citizen nurses. BACKGROUND Evaluating nurses' professional competence is vital in delivering safe, cost-effective care and developing healthcare systems. However, psychometrically reliable and validated nurse competence scales in Arabic-speaking countries remain scant. DESIGN A descriptive cross-sectional design adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS Participant nurses (n = 598) were conveniently recruited from four government-owned hospitals and completed the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form. We used Spearman's rank-order correlation, exploratory factor analysis, Kaiser-Meyer-Olkin test, and confirmatory factor analysis to analyze the data. RESULTS After exploratory factor analysis and reliability analyses, several items of the Arabic-translated 35-item Nurse Professional Competence Scale-Short Form were omitted due to high inter-item correlations and low factor loading difference. The Arabic version of the Nurse Professional Competence Scale-Short Form was reduced to 21 items, consisting of a three-factor structure: Professional Care Pedagogics, Holistic Value-Based Care, and Direct Nursing Care. Results also demonstrated that the revised three-factor structure had good overall scale reliability, good subscale internal consistencies, and acceptable construct validity using the confirmatory factor analysis. CONCLUSION The 21-item Nurse Professional Competence Scale-Short Form Arabic version is a useful scale, having demonstrated construct validity and reliability. Therefore, nurse managers in Arabic-speaking nations could assess their nurses' professional competence using the 21-item Nurse Professional Competence Scale-Short Form Arabic version to develop proactive programs that enhance professional competence.
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Affiliation(s)
- Rizal Angelo N Grande
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il City 55473, Saudi Arabia.
| | | | - Larry Terrence O Cornejo
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il City 55473, Saudi Arabia
| | - Hazel N Villagracia
- Medical-Surgical Nursing Department, College of Nursing, University of Ha'il, Ha'il City 55473, Saudi Arabia
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Chesterton L, Tetley J, Cox N, Jack K. A hermeneutical study of professional accountability in nursing. J Clin Nurs 2020; 30:188-199. [PMID: 33091169 DOI: 10.1111/jocn.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings. BACKGROUND Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care. DESIGN This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study. RESULTS The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being. RELEVANCE TO CLINICAL PRACTICE Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment.
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Affiliation(s)
- Lorna Chesterton
- Social Ageing Cluster, Manchester Metropolitan University, Manchester, UK
| | - Josie Tetley
- Faculty of Health, Psychology and Social Care (Nursing), Manchester Metropolitan University, Manchester, UK
| | - Nigel Cox
- Faculty of Health, Psychology and Social Care (Nursing), Manchester Metropolitan University, Manchester, UK
| | - Kirsten Jack
- Faculty of Health, Psychology and Social Care (Nursing), Manchester Metropolitan University, Manchester, UK
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Weigl M, Händl T, Wehler M, Schneider A. [Time-allocation study of nurse and physician activities in the emergency department]. Med Klin Intensivmed Notfmed 2020; 116:229-237. [PMID: 32072195 PMCID: PMC8016769 DOI: 10.1007/s00063-020-00657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/09/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
Abstract
Hintergrund Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich. Ziel der Arbeit Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel. Material und Methoden Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen. Ergebnisse Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede. Diskussion Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00063-020-00657-4) enthält die Tabelle S1. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- M Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.
| | - T Händl
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - M Wehler
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - A Schneider
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.,Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Iordache S, Elseviers M, De Cock R, Van Rompaey B. Development and validation of an assessment tool for nursing workload in emergency departments. J Clin Nurs 2019; 29:794-809. [PMID: 31737962 DOI: 10.1111/jocn.15106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
AIMS To develop the Workload Assessment of Nurses on Emergency (WANE) tool and to test its validity and reliability to measure nursing workload in the emergency departments. BACKGROUND Ensuring safe nursing staffing in emergency departments is a worldwide concern. There is no valid tool to measure emergency nursing workload in order to determine the needed nurse staffing in the emergency departments. DESIGN A two-year, cross-sectional, multicenter study. METHODS Workload was operationalised as the time nurses spent with nursing activities, classified into direct and indirect care. A board of experts provided content validity. Construct validity was evaluated by examining the WANE's correlations and group-discriminations patterns within the network of variables known to determine nursing workload. Reliability was assessed by the tool's ability to yield consistent results across repeated measurements. Reporting of this research adheres to STROBE guidelines. RESULTS Seven emergency departments, including 3,024 patients, were involved in the first year and 18 emergency departments and 7,442 patients in the second year. Direct care time correlated positively and significantly with patient dependency on nursing care, age and length of emergency department stay and discriminated between the categories of dependency on nursing care, age and hospitalisation. Both direct and indirect care time discriminated between the emergency departments according to different patient care profiles and unit characteristics. WANE showed consistent results across measurements. CONCLUSIONS Results support the WANE's reliability and validity to measure emergency nursing workload. This tool could be used to determine, on patient and unit, a baseline nurse staffing and the nursing skill mix in the emergency departments. WANE is also an evidence-based management tool for benchmarking purposes. RELEVANCE TO CLINICAL PRACTICE The use of an evidence-based workload tool in making staffing decisions in emergency departments is crucial to ensure safe patient care and prevent work overload in nursing staff.
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Affiliation(s)
- Steluta Iordache
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium
| | - Monique Elseviers
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium.,Clinical Pharmacology, Heymans Institute, University of Ghent, Ghent, Belgium
| | - Rita De Cock
- Nursing Department, Imelda Hospital, Bonheiden, Belgium
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, Division of Nursing Science and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium.,Department of Health and Social Care, Artesis Plantijn University College of Antwerp, Merksem, Belgium
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Fann WC, Lee BO, Hsiao CT, Chuan YS, Kuo CY. Do Emergency Nurses Spend Enough Time on Nursing Activities? The Relationship Between Actual and Expected Patient Care Nursing Time. J Acute Med 2019; 9:161-171. [PMID: 32995246 DOI: 10.6705/j.jacme.201912_9(4).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The overcrowded environments of emergency departments (EDs) lead to increased clinical workloads for nurses and infl uences the quality of patient care. This study aimed to evaluate whether the quality of patient care meets the expectations of emergency nurses in Taiwan by measuring the amount of time nurses spend on patient care activities. Methods The direct observation study was conducted in one suburban academic hospital with approximately 80,000 annual ED visits. This study observed emergency nurses and the time they spent on their nursing activities. The directly measured times and nurse expected patient care nursing times were compared. Results For all 88 types of nursing activities recorded, each measured nursing time was less than the expected nursing time. On average, the measured nursing time was 82% less than the expected nursing time (2.0 ± 0.3 minutes vs. 11.6 ± 1.5 minutes, p < 0.01). Among the 88 types of nursing activities recorded, the average measured time spent on 76 types (86%) was less than 3 minutes. The nursing activity on which the longest time was spent was cerebrospinal fl uid study nursing (7 minutes). The most frequent nursing activity was documentation. Conclusion The nursing time spent on patient-care activities in EDs was much less than the nurses expected. The results may provide a basis for nursing quality measurements and manpower calculations for EDs.
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Affiliation(s)
- Wen-Chih Fann
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan
| | - Bih-O Lee
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
| | - Cheng-Ting Hsiao
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan.,Chang Gung University School of Traditional Chinese Medicine Taoyuan Taiwan
| | - Yu-Shan Chuan
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan
| | - Chiu-Ya Kuo
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
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Behringer W, Graeff I, Dietz-Wittstock M, Wrede CE, Mersmann J, Pin M, Kumle B, Möckel M, Gries A, Eisenburger P, Exadaktylos A, Dodt C. Empfehlungen der notfallmedizinischen Gesellschaften DGINA, AAEM, SGNOR, DIVI, DGAI und DGIIN zur pflegerischen Besetzung von Klinischen Notfallzentren. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hunter D, McCallum J, Howes D. Compassion in emergency departments. Part 2: barriers to the provision of compassionate care. Emerg Nurse 2018; 26:e1775. [PMID: 30047712 DOI: 10.7748/en.2018.e1775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 06/08/2023]
Abstract
In the second part of this three-part series, David Hunter and colleagues discuss the barriers to the provision of compassionate care in emergency departments (EDs). Part one reported findings from doctoral-level research exploring nursing students' experiences of compassionate care in EDs. Many of the findings related to what the students considered as barriers to the provision of compassionate care in this clinical environment. Six barriers to compassionate care were identified and this article considers them in detail.
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Affiliation(s)
- David Hunter
- University of the West of Scotland, Renfrewshire, Scotland
| | | | - Dora Howes
- School of Medicine, Dentistry and Nursing, University of Glasgow, Singapore
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9
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Nelson D, Hearld LR, Wein D. The Impact of Emergency Department RN Staffing on ED Patient Experience. J Emerg Nurs 2018; 44:394-401. [DOI: 10.1016/j.jen.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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10
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Van Bockstal E, Maenhout B. A study on the impact of prioritising emergency department arrivals on the patient waiting time. Health Care Manag Sci 2018; 22:589-614. [PMID: 29725894 DOI: 10.1007/s10729-018-9447-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
Abstract
In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the 𝜖-constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.
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Affiliation(s)
- Ellen Van Bockstal
- Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat, 2 - 9000, Gent, Belgium
| | - Broos Maenhout
- Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat, 2 - 9000, Gent, Belgium.
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Rasouli A, Hosseini SM, Bahadori M, Ravangard R. Characteristics of Occupational Injuries in a Pharmaceutical Company in Iran. Bull Emerg Trauma 2018; 6:155-161. [PMID: 29719847 DOI: 10.29252/beat-060210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP). Methods This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method (N=n=130 employees). A data collection form was designed for identifying the hazards using the Nominal Group Technique (NGT) method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0. Results The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" (W=0.253) and "being exposed to radiation" (W=0.022) in the laboratory unit, "skin injuries" (W=0.205) and "bending and straightening for a long time" (W= 0.032) in the production unit, "falling down" (W=0.271) and "standing and sitting for a long time " (W=0.037) in the installations and facilities unit, and "hand joint failure" (W=0.295) and "working in a low-light environment" (W=0.092) in the administrative unit. Conclusion The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company's units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential.
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Affiliation(s)
- Abbas Rasouli
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Ross C, Rogers C. RN? Registered or rubber nurse? Collegian 2017. [DOI: 10.1016/j.colegn.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Baril C, Gascon V, Miller J, Bounhol C. Studying nurse workload and patient waiting time in a hematology-oncology clinic with discrete event simulation. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/19488300.2016.1226212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gräff I, Goldschmidt B, Glien P, Klockner S, Erdfelder F, Schiefer JL, Grigutsch D. Nurse Staffing Calculation in the Emergency Department - Performance-Oriented Calculation Based on the Manchester Triage System at the University Hospital Bonn. PLoS One 2016; 11:e0154344. [PMID: 27138492 PMCID: PMC4854466 DOI: 10.1371/journal.pone.0154344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 04/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe. Material and Methods Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS), taking into account specific workload fluctuations (50th-95th percentiles). Results Patients classified to the MTS category red (n = 35) required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118), nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181), 40.95 min, while the two MTS categories with the least acute patients, green (n = 129) and blue (n = 40) required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010) emergency patients, 67–123 emergency patients (50–95% percentile) per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1. Conclusion Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.
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Affiliation(s)
- Ingo Gräff
- Emergency Department, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | | | - Procula Glien
- Emergency Department, University Hospital Bonn, Bonn, Germany
| | - Sophia Klockner
- Department of Anesthesiology, Hospital Mechernich, Mechernich, Germany
| | - Felix Erdfelder
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Lynn Schiefer
- Department for Plastic, Hand, Reconstructive and Burn Surgery, Hospital Köln-Merheim, Köln, Germany
| | - Daniel Grigutsch
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
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15
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Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study. Int Emerg Nurs 2016; 25:37-42. [DOI: 10.1016/j.ienj.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/05/2015] [Accepted: 07/16/2015] [Indexed: 11/23/2022]
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16
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Ka-Ming Ho J. Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Appl Nurs Res 2016; 29:e7-13. [DOI: 10.1016/j.apnr.2015.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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17
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Recio-Saucedo A, Pope C, Dall'Ora C, Griffiths P, Jones J, Crouch R, Drennan J. Safe staffing for nursing in emergency departments: evidence review. Emerg Med J 2015; 32:888-94. [DOI: 10.1136/emermed-2015-204936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/08/2015] [Indexed: 11/03/2022]
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18
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Khademi M, Mohammadi E, Vanaki Z. Resources-tasks imbalance: Experiences of nurses from factors influencing workload to increase. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:476-83. [PMID: 26257804 PMCID: PMC4525347 DOI: 10.4103/1735-9066.160994] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 12/24/2014] [Indexed: 11/24/2022]
Abstract
Background: While nursing workload is a worldwide challenge, less attention has been given to the determining factors. Understanding these factors is important and could help nursing managers to provide suitable working environment and to manage the adverse outcomes of nursing workload. The aim of this study was to discover nurses’ experiences of determinant factors of their workload. Materials and Methods: In this qualitative study, the participants included 15 nurses working in two hospitals in Tehran, Iran. The data were collected through 26 unstructured interviews and were analyzed using conventional content analysis. The rigor has been guaranteed with prolonged engagement, maximum variance sampling, member check, and audit trail. Results: Resource–task imbalance was the main theme of nurses’ experiences. It means that there was an imbalance between necessary elements to meet patients’ needs in comparison with expectation and responsibility. Resource–task imbalance included lack of resource, assignment without preparation, assigning non-care tasks, and patients’ and families’ needs/expectations. Conclusions: A deep and comprehensive imbalance between recourses and tasks and expectations has been perceived by the participants to be the main source of work overload. Paying more attention to resource allocation, education of quality workforce, and job description by managers is necessary.
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Affiliation(s)
- Mojgan Khademi
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
| | - Easa Mohammadi
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
| | - Zohreh Vanaki
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
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Miltner RS, Johnson KD, Deierhoi R. Exploring the Frequency of Blood Pressure Documentation in Emergency Departments. J Nurs Scholarsh 2013; 46:98-105. [DOI: 10.1111/jnu.12060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Rebecca S. Miltner
- Assistant Professor, School of Nursing; University of Alabama at Birmingham, Birmingham; AL and Birmingham VA Medical Center; Birmingham AL
| | - Kimberly D. Johnson
- Assistant Professor, College of Nursing; University of Cincinnati; Cincinnati OH
| | - Rhiannon Deierhoi
- Department of GI Surgery; University of Alabama at Birmingham; AL and Birmingham VA Medical Center; Birmingham AL
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20
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Williams G, Crilly J, Souter J, Veach K, Good N. A state wide validation and utilisation study of the Queensland emergency nursing workforce tool. J Nurs Manag 2013; 22:1076-88. [DOI: 10.1111/jonm.12063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ged Williams
- Gold Coast Health Service District; Gold Coast Queensland Australia
- Health Practice Innovation; Griffith Health Institute; Griffith University; Gold Coast Queensland Australia
| | - Julia Crilly
- Health Practice Innovation; Griffith Health Institute; Griffith University; Gold Coast Queensland Australia
- State Wide Emergency Department Clinical Network; Gold Coast Hospital; Southport Queensland Australia
| | - Jeffrey Souter
- Nursing Clinical Support Unit; Townsville Hospital; Townsville Queensland Australia
| | - Kate Veach
- Business Planning Framework Project; Nursing and Midwifery Office; Brisbane Queensland Australia
| | - Norm Good
- Division of Mathematics; Informatics & Statistics; CSIRO; Royal Brisbane and Women's Hospital; Herston Queensland Australia
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21
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Rathlev NK, Obendorfer D, White LF, Rebholz C, Magauran B, Baker W, Ulrich A, Fisher L, Olshaker J. Time series analysis of emergency department length of stay per 8-hour shift. West J Emerg Med 2012; 13:163-8. [PMID: 22900106 PMCID: PMC3415804 DOI: 10.5811/westjem.2011.7.6743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 06/12/2011] [Accepted: 07/29/2011] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The mean emergency department (ED) length of stay (LOS) is considered a measure of crowding. This paper measures the association between LOS and factors that potentially contribute to LOS measured over consecutive shifts in the ED: shift 1 (7:00 am to 3:00 pm), shift 2 (3:00 pm to 11:00 pm), and shift 3 (11:00 pm to 7:00 am). METHODS SETTING University, inner-city teaching hospital. PATIENTS 91,643 adult ED patients between October 12, 2005 and April 30, 2007. DESIGN For each shift, we measured the numbers of (1) ED nurses on duty, (2) discharges, (3) discharges on the previous shift, (4) resuscitation cases, (5) admissions, (6) intensive care unit (ICU) admissions, and (7) LOS on the previous shift. For each 24-hour period, we measured the (1) number of elective surgical admissions and (2) hospital occupancy. We used autoregressive integrated moving average time series analysis to retrospectively measure the association between LOS and the covariates. RESULTS For all 3 shifts, LOS in minutes increased by 1.08 (95% confidence interval 0.68, 1.50) for every additional 1% increase in hospital occupancy. For every additional admission from the ED, LOS in minutes increased by 3.88 (2.81, 4.95) on shift 1, 2.88 (1.54, 3.14) on shift 2, and 4.91 (2.29, 7.53) on shift 3. LOS in minutes increased 14.27 (2.01, 26.52) when 3 or more patients were admitted to the ICU on shift 1. The numbers of nurses, ED discharges on the previous shift, resuscitation cases, and elective surgical admissions were not associated with LOS on any shift. CONCLUSION Key factors associated with LOS include hospital occupancy and the number of hospital admissions that originate in the ED. This particularly applies to ED patients who are admitted to the ICU.
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Affiliation(s)
- Niels K. Rathlev
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Dan Obendorfer
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Laura F. White
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Casey Rebholz
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Brendan Magauran
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Willie Baker
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Andrew Ulrich
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Linda Fisher
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Jonathan Olshaker
- Boston University Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Impact of antibiotic exposure patterns on selection of community-associated methicillin-resistant Staphylococcus aureus in hospital settings. Antimicrob Agents Chemother 2011; 55:4888-95. [PMID: 21788461 DOI: 10.1128/aac.01626-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Community-associated methicillin-resistant S. aureus (CA-MRSA) is increasingly common in hospitals, with potentially serious consequences. The aim of this study was to assess the impact of antibiotic prescription patterns on the selection of CA-MRSA within hospitals, in a context of competition with other circulating staphylococcal strains, including methicillin-sensitive (MSSA) and hospital-associated methicillin-resistant (HA-MRSA) strains. We developed a computerized agent-based model of S. aureus transmission in a hospital ward in which CA-MRSA, MSSA, and HA-MRSA strains may cocirculate. We investigated a wide range of antibiotic prescription patterns in both intensive care units (ICUs) and general wards, and we studied how differences in antibiotic exposure may explain observed variations in the success of CA-MRSA invasion in the hospitals of several European countries and of the United States. Model predictions underlined the influence of antibiotic prescription patterns on CA-MRSA spread in hospitals, especially in the ICU, where the endemic prevalence of CA-MRSA carriage can range from 3% to 20%, depending on the simulated prescription pattern. Large antibiotic exposure with drugs effective against MSSA but not MRSA was found to promote invasion by CA-MRSA. We also found that, should CA-MRSA acquire fluoroquinolone resistance, a major increase in CA-MRSA prevalence could ensue in hospitals worldwide. Controlling the spread of highly community-prevalent CA-MRSA within hospitals is a challenge. This study demonstrates that antibiotic exposure strategies could participate in this control. This is all the more important in wards such as ICUs, which may play the role of incubators, promoting CA-MRSA selection in hospitals.
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Myny D, Van Goubergen D, Gobert M, Vanderwee K, Van Hecke A, Defloor T. Non-direct patient care factors influencing nursing workload: a review of the literature. J Adv Nurs 2011; 67:2109-29. [DOI: 10.1111/j.1365-2648.2011.05689.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thibodeau LG, Geary SP, Werter C. An evaluation of resident work profiles, attending-resident teaching interactions, and the effect of variations in emergency department volume on each. Acad Emerg Med 2010; 17 Suppl 2:S62-6. [PMID: 21199086 DOI: 10.1111/j.1553-2712.2010.00892.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examines the effect of variations in emergency department (ED) volume on physician work efficiency (new patients per hour) and work profile (patient-related activities, including both direct and indirect patient care) and whether these differ between first- (Postgraduate Year [PGY]1) and third- (PGY3) year residents. The authors also determine if changes in volume are associated with changes in teaching interactions between attending and resident physicians. METHODS This was a prospective observational study of resident and attending physicians in the ED. Research assistants (RAs) followed ED residents during clinical shifts and recorded a multitude of data including the amount of time spent in specific activities, the number of new patients seen, and the frequency of attending physician teaching interactions. RESULTS Third-year residents see more new patients per hour (1.79 vs. 1.16, p < 0.001) than do their first-year counterparts. In addition, third-year residents spend almost 50% less time with each patient (10.7 minutes vs. 19.4 minutes, p < 0.001), and first-year residents spend three times as much time per shift discussing patients with attending physicians (59.4 minutes vs. 27.3 minutes, p = 0.002). More of the PGY1/attending interactions resulted in educational exchanges (54.9% vs. 34.6%, p = 0.003). PGY1 residents also spend more time on dictations per patient (9.6 minutes vs. 5.4 minutes, p = 0.01) and more time on paperwork per patient (18.5 minutes vs. 6.5 minutes, p = 0.007). As ED volume tripled, PGY1 residents were able to increase their patient load to a greater extent than were PGY3 residents by decreasing the length of each patient encounter as volume increased. Overall, ED volume had no effect on the number of teaching interactions, although the length of exchange decreased as volume increased. CONCLUSIONS Third-year residents see and carry more patients than do their first-year counterparts. They do so primarily by decreasing the amount of time spent with patients and attendings and working more efficiently overall. However, they are not as capable of altering their work profiles in the face of increased volume as their first-year counterparts. While the length of teaching interactions is decreased as volume increases, the number of those interactions resulting in teaching remains constant regardless of volume.
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Myny D, Van Goubergen D, Limère V, Gobert M, Verhaeghe S, Defloor T. Determination of standard times of nursing activities based on a Nursing Minimum Dataset. J Adv Nurs 2010; 66:92-102. [PMID: 20423437 DOI: 10.1111/j.1365-2648.2009.05152.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study conducted to determine the standard time per nursing activity and the proportion of nursing time covered by the nursing activities of the Belgian Nursing Minimum Dataset compared to the total time of a nurse shift, and to evaluate the correlation between hospital size and standard times of nursing activities. BACKGROUND Because of a shrinking workforce and rising workload, nursing managers need tools that help them to allocate their staff to the wards. Such tools should be based on objective time measurements. METHODS The study was performed in surgical, internal medicine and elder care wards in an acute hospital care setting. In the first phase, a two-round Delphi-procedure was used to operationalize the definitions of nursing activities. In the second phase, the standard time for each nursing activity was determined, based on data collected over a 6-month period during 2006-2007. A combination of 13,292 work sampling observations by external observers, 3000 recordings of direct time measurement by self-recording and subjective time assessments yielded times that were used to analyse the duration of the nursing activities. RESULTS A standard time for 102 nursing activities was established. The coverage of the Belgian Nursing Minimum Dataset in the surgical, internal medicine and elder care wards was 47.5%, 46.4% and 51.0% respectively. The Belgian Nursing Minimum Dataset was found to cover almost 70% of direct and indirect nursing care. CONCLUSION Further research is needed to assess the impact on the standard times of nursing activities of inefficient organizational structures and different cultural interpretations of the way an activity is conducted.
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Affiliation(s)
- Dries Myny
- Department of Nursing, University Hospital of Ghent, Ghent, Belgium.
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Gabbay U, Bukchin M. Does daily nurse staffing match ward workload variability? Three hospitals' experiences. Int J Health Care Qual Assur 2010; 22:625-41. [PMID: 19957423 DOI: 10.1108/09526860910986885] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. DESIGN/METHODOLOGY/APPROACH Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). FINDINGS A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. RESEARCH LIMITATIONS/IMPLICATIONS The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. PRACTICAL IMPLICATIONS Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity. The real challenge will be to develop planning systems and implement corrective interventions such as dynamic and flexible daily staffing, which will face difficulties and barriers. ORIGINALITY/VALUE The paper fulfils the need for workforce utilization evaluation. A simple method using available data for daily staffing appropriateness evaluation, which is easy to implement and operate, is presented. The statistical process control method enables intra-ward evaluation, while standardization by converting crude into relative measures enables inter-ward analysis. The staffing indicator definitions enable performance evaluation. This original study uses statistical process control to develop simple standardization methods and applies straightforward statistical tools. This method is not limited to crude measures, rather it uses weighted workload measures such as nursing acuity or weighted nurse level (i.e. grade/band).
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Affiliation(s)
- Uri Gabbay
- Epidemiology Section, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Many nosocomial outbreaks exhibit "superspreading events" in which cross-transmission occurs via a single individual to a large number of patients. We investigated how heterogeneity in Health-Care Worker (HCW) behaviors, especially compliance to hand hygiene, may cause superspreading events. In particular, we compared the superspreading potential of peripatetic (noncohorted) HCWs with that of other HCWs. We developed an agent-based model for hand transmission of a pathogen in a hospital ward. Three HCW profiles were allowed: 2 assigned profiles, one with frequent contacts with a limited number of patients, another with fewer contacts but with more patients; and one peripatetic profile, with a single daily contact with all patients. We used data from the literature on common nosocomial pathogens (Staphylococcus aureus, Enterococci). The average number of patients colonized over 1 month increases with noncompliance to hand hygiene. Importantly, we show that this increase depends on the profile of noncompliant HCWs; for instance, it remains low for a single noncompliant assigned HCW but can be quite large for a single noncompliant peripatetic HCW. Outbreaks with this single fully noncompliant peripatetic HCW (representing only 4.5% of the staff) are similar to those predicted when all HCWs are noncompliant following 23% of patient contacts. Noncompliant peripatetic HCWs may play a disproportionate role in disseminating pathogens in a hospital ward. Their unique profile makes them potential superspreaders. This suggests that average compliance to hygiene may not be a good indicator of nosocomial risk in real life health care settings with several HCW profiles.
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Abstract
Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse's work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses' work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.
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de Jong AEE, Leeman J, Middelkoop E. Development of a nursing workload measurement instrument in burn care. Burns 2009; 35:942-8. [PMID: 19577371 DOI: 10.1016/j.burns.2009.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 04/14/2009] [Accepted: 04/15/2009] [Indexed: 11/28/2022]
Abstract
Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients' care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.
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Affiliation(s)
- Alette E E de Jong
- Burn Centre, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.
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Beckstrand RL, Smith MD, Heaston S, Bond AE. Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care. J Emerg Nurs 2008; 34:290-300. [PMID: 18640407 DOI: 10.1016/j.jen.2007.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/20/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Emergency nurses care for dying patients daily. The process of dying in an emergency department can be complicated. Research on specific obstacles that impede the delivery of end-of-life care in emergency departments and behaviors that support it is limited. METHODS A 70-item questionnaire was mailed to randomly selected ENA members. Subjects were asked to rate items on the size, frequency, and magnitude of obstacles and supportive behaviors that relate to end-of-life care for ED patients. RESULTS The perceived obstacles with the greatest magnitude were as follows: (a) ED nurses' work loads being too high to allow adequate time for patient care, (b) poor design of emergency departments, and (c) family members not understanding what "life-saving measures" really mean. The three highest-scoring supportive behaviors were as follows: (a) allowing family members adequate time to be alone with the patient after he or she has died; (b) having good communication between the physician and RN; and (c) providing a peaceful, dignified bedside scene for family members once the patient has died. DISCUSSION It is hoped that the results of this study will help increase and facilitate the discussions regarding end-of-life care in emergency departments. Realistic initial implications include finding ways to decrease workloads of emergency nurses and increase direct patient care. Another important implication would be the improvement of ED designs. Further research in the area of end-of-life care in emergency settings is recommended.
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Affiliation(s)
- Renea L Beckstrand
- Brigham Young University, College of Nursing, 422 SWKT, PO Box 25432, Provo, UT 84602-5432, USA.
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