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Haughey M, Harman M, Hopkins C, Watson A, Goodwin C, Hines J, Sullivan K, Gonzaga C, Washburn A, Neyens DM. Development and Evaluation of a Metric-based Clinical Simulation Procedure for Assessing Ostomy Care in Nursing Practice. Clin Simul Nurs 2024; 94:101579. [PMID: 39183981 PMCID: PMC11340653 DOI: 10.1016/j.ecns.2024.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background There is a need to understand the clinical decision-making and work practices within ostomy nursing care to support expanding nursing training. Objective To develop and evaluate a new metric-based simulation for assessing ostomy nursing care using a human factors approach. Sample This pilot study involved eleven stakeholders in the needs assessment, six nurse participants performing simulated ostomy care, and three independent observers assessing procedure reliability. Method We conducted a needs assessment of ostomy nursing care and training, developed an enhanced metric-based simulation for ostomy appliance change procedures, and statistically evaluated its reliability for measuring the simulated tasks. Results The enhanced metric-based simulation captured different tasks within four task categories: product selection; stoma and peristomal skin care; baseplate sizing and adhesion; and infection control strategies. The video review procedure was reliable for assessing continuous (average ICC≥0.96) and categorical (average κ>0.96) variables. Conclusion The new metric-based simulation was suitable for characterizing a broad range of clinical decision-making and work practices in ostomy nursing care.
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Affiliation(s)
- Marketa Haughey
- Dept. of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634 USA
| | - Melinda Harman
- Dept. of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634 USA
| | - Casey Hopkins
- School of Nursing, Clemson University, 605 Grove Road, Greenville, SC 29605 USA
| | - Amanda Watson
- School of Nursing, Clemson University, 605 Grove Road, Greenville, SC 29605 USA
| | - Corbin Goodwin
- Dept. of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634 USA
| | - Jenna Hines
- Dept. of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634 USA
| | - Katelyn Sullivan
- School of Nursing, Clemson University, 605 Grove Road, Greenville, SC 29605 USA
| | - Chris Gonzaga
- Dept. of Industrial Engineering, 100 Freeman Hall, Clemson University, Clemson, SC 29634 USA
| | - Abigail Washburn
- Wound Healing and Hyperbaric Medicine Center-Greenville, Prisma Health-Upstate, 200 Patewood Drive, Suite C300, Greenville, SC 29615 USA
| | - David M Neyens
- Dept. of Industrial Engineering, 100 Freeman Hall, Clemson University, Clemson, SC 29634 USA; Dept. of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634 USA
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Ransolin N, Saurin TA, Clay-Williams R, Formoso CT, Rapport F. A knowledge framework for the design of built environment supportive of resilient internal logistics in hospitals. APPLIED ERGONOMICS 2024; 116:104209. [PMID: 38134718 DOI: 10.1016/j.apergo.2023.104209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Internal logistics is crucial for hospitals, occurring within facilities that pose constraints and opportunities, demanding resilient performance (RP) to adapt to dynamic conditions and balance safety and efficiency pressures. However, the role of the built environment (BE) to support RP is not explicitly analysed in the hospital logistics literature, which is usually limited to discuss BE in terms of layout and routing issues. To address this gap, this study presents a knowledge framework of BE supportive of RP in internal hospital logistics. The framework was developed based on a study in a large teaching hospital, encompassing 11 service flows of people and supplies between an intensive care unit and other units. Data collection was based on 38 interviews, documents such as floor plans, and observations of logistics activities. Seven BE design principles developed in a previous study, concerned with RP in general but not focused on logistics, were adopted as initial themes for data analysis. Results of the thematic analysis gave rise to a knowledge framework composed of seven design prescriptions and 63 practical examples of BE supportive of RP in hospital internal logistics. The paper discusses how these prescriptions and examples are connected to resilience management. The framework is new in the context of internal hospital logistics and offers guidance to both BE and logistics designers.
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Affiliation(s)
- Natália Ransolin
- PPGCI/UFRGS (Construction Management and Infrastructure Post-Graduation Program, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, Porto Alegre, RS, CEP 90035-190, Brazil; AIHI/MQ (Australian Institute of Health Innovation, Macquarie University), Av. Osvaldo Aranha, 99, Porto Alegre, RS, CEP 90035-190, Brazil.
| | - Tarcisio Abreu Saurin
- DEPROT/UFRGS (Industrial Engineering and Transportation Department, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, Porto Alegre, RS, CEP 90035-190, Brazil.
| | - Robyn Clay-Williams
- AIHI/MQ (Australian Institute of Health Innovation, Macquarie University), 75 Talavera Rd, North Ryde, Sydney, NSW, 2113, Australia.
| | - Carlos Torres Formoso
- PPGCI/UFRGS (Construction Management and Infrastructure Post-Graduation Program, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, Porto Alegre, RS, CEP 90035-190, Brazil.
| | - Frances Rapport
- AIHI/MQ (Australian Institute of Health Innovation, Macquarie University), 75 Talavera Rd, North Ryde, Sydney, NSW, 2113, Australia.
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Manworren RCB. Nurses' management of children's acute postoperative pain: A theory of bureaucratic caring deductive study. J Pediatr Nurs 2022; 64:42-55. [PMID: 35149258 DOI: 10.1016/j.pedn.2022.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies have examined the translation of nurses' knowledge of pain management into clinical practice or how nurses negotiated the bureaucracy of caring to treat patients' acute pain. PURPOSE This study describes factors that influence pediatric nurses' actions in caring for hospitalized children's acute post-surgical pain. METHOD Ray's Theory of Bureaucratic Caring provided the theoretical framework for this mixed methods study of ethnography and human factors engineering. Fourteen nurses were observed throughout their shifts (175.5 h) to elucidate humanistic and bureaucratic influences. FINDINGS Of 105 pain assessments, nurses intervened with pharmacologic (n = 45) and biobehavioral (n = 13) interventions for pediatric patients' post-surgical pain in less than 11 min; and 25 assessments revealed patients did not have pain. Pain was assessed and no intervention was provided to 4 patients who were asleep, 5 patients who refused, 2 patients who had no ordered analgesics and 10 patients who were assessed prior to peak effectiveness of their prior analgesic. Overall pain was well-controlled. Of the 28 themes identified, the interplay of 6 categorized to the social/cultural humanistic, 7 political, and 6 technologic/physiological bureaucratic dimensions most strongly influenced pain care. DISCUSSION To achieve optimal pain care outcomes, nurses' and parents' pain management knowledge was less influential for clinical practice translation than nurses' negotiation of other dimensions of bureaucratic caring.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA.
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Ransolin N, Saurin TA, Zani CM, Rapport F, Formoso CT, Clay-Williams R. The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:329-350. [PMID: 35168374 DOI: 10.1177/19375867221077469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. BACKGROUND Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. METHOD This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. RESULTS The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. CONCLUSIONS The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.
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Affiliation(s)
- Natália Ransolin
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tarcisio Abreu Saurin
- Industrial Engineering and Transportation Department (DEPROT), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Carolina Melecardi Zani
- Bartlett School of Sustainable Construction (BSSC), University College London (UCL), United Kingdom
| | - Frances Rapport
- Australian Institute of Health Innovation (AIHI), Macquarie University, Sydney, New South Wales, Australia
| | - Carlos Torres Formoso
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation (AIHI), Macquarie University, Sydney, New South Wales, Australia
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Michel O, Garcia Manjon AJ, Pasquier J, Ortoleva Bucher C. How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit. J Adv Nurs 2021; 77:4459-4470. [PMID: 34133039 PMCID: PMC8518809 DOI: 10.1111/jan.14935] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. Design A single‐centre observational descriptive study. Method Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions. Results A total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time. Conclusion This study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice. Impact Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.
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Affiliation(s)
- Olivia Michel
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Health Sciences (HEdS-FR), University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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Jackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud 2021; 122:103944. [PMID: 34325358 DOI: 10.1016/j.ijnurstu.2021.103944] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is ample evidence that modern nurses are under strain and that interventions to support the nursing workforce have not recognised the complexity inherent in nursing work. Creating a modern model of nursing work may assist nurses in developing workable solutions to professional problems. A new model may also foster cohesion among broad and diverse nursing roles. AIM The aim of this meta-narrative review was to investigate how researchers, using different methods and theoretical approaches, have contributed to the understanding of nursing work. METHODS A meta-narrative review was done to evaluate the trajectory of nursing work research, from 1953 to present. This review progressed through the stages of planning, searching, mapping, appraisal, and synthesis. FINDINGS A total of 121 articles were included in this meta-narrative review. These articles revealed five narratives of nursing work, where work is conceptualised as labour. These narratives were physical labour (n = 14), emotional (n = 53), cognitive (n = 24), and organisational (n = 1), and combinations of more than one type of labour (n = 29 articles). The paradigms identified in the meta-narrative were the positivist, interpretive, critical, and evidence-based paradigms. Each article in the review corresponded with a paradigm and a labour narrative, creating a comprehensive model. CONCLUSIONS Nursing work can be understood as a model of physical, emotional, cognitive, and organisational labour. These different types of labour may be hidden and taken for granted. Nurses can use this model to articulate what they do and how it supports patient safety. Nurses can also advocate for staffing allocations that consider all types of nursing labour. Tweetable abstract Nursing work is complex and includes physical, emotional, cognitive, and organisational labour. Staffing needs to take all nursing labour into account.
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Affiliation(s)
- Jennifer Jackson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK.
| | - Janet E Anderson
- Professor of Quality of Care for Older People, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH UK.
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Dahlberg K, Brady JM, Jaensson M, Nilsson U, Odom-Forren J. Education, Competence, and Role of the Nurse Working in the PACU: An International Survey. J Perianesth Nurs 2021; 36:224-231.e6. [PMID: 33526336 DOI: 10.1016/j.jopan.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/20/2020] [Accepted: 08/15/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this research project was to describe the education, competence, and role of nurses working in the postanesthesia care unit (PACU) in 11 countries having an established perianesthesia specialty nursing organization and membership on the International Collaboration of PeriAnaesthesia Nurses, Inc (ICPAN) Global Advisory Council (GAC). DESIGN This is a descriptive international cross-sectional study. METHODS A Web-based survey was distributed to members of the ICPAN GAC to be completed by the GAC representative or another expert perianesthesia nurse member from the organization (n = 11). The GAC has one representative from the following 11 ICPAN organizational members: ACPAN, Australian College of PeriAnaesthesia Nurses (Australia); BRV, Beroepsvereniging Recovery Verpleegkundigen (Belgium/The Netherlands); NAPANc, National Association of PeriAnesthesia Nurses of Canada (Canada); FSAIO, The Danish Association of Anaesthesia, Intensive Care and Recovery Nurses (Denmark); FANA, Finnish Association of Nurse Anaesthetists (Finland); Hellenic Perianesthesia Nursing Organization (Greece); IARNA, Irish Anaesthetic and Recovery Nurses Association (Ireland); PNC of NZNO, Perioperative Nurses College of the New Zealand Nurses Organisation (New Zealand); ANIVA, Swedish Association of Nurse Anesthetists and Intensive Care Nurses (Sweden); BARNA, British Anaesthetic and Recovery Nurses Association (United Kingdom); and ASPAN, American Society of PeriAnesthesia Nurses (USA). FINDINGS Perianesthesia nursing was recognized as a professional nursing specialty in 6 of 11 countries, and 8 of 11 have established national guidelines or practice standards for perianesthesia nurses. The Netherlands, Ireland, and Australia are the only countries that have a formal education program for perianesthesia nurses. There were variations in nurse-to-patient ratios between the 11 countries, ranging from 2:1 to 1:3 in the Phase I recovery of critically ill patients; in Phase II recovery (day surgery) it was most common to have up to three to four patients per nurse. Perianesthesia nurses were mainly the only profession stationed in the PACU, with professions such as the anesthesiologist and surgeon on call. The nurses performed many job tasks autonomously; however, this differed between countries. CONCLUSIONS Perianesthesia nurse education, clinical guidelines, other professions working in the PACU, and job tasks differ between countries. This knowledge can be used in international collaboration to further develop education and training for nurses working in the PACU. Continued international perianesthesia nursing partnership can only bring us closer and strengthen our specialty practice with the focus not on our differences but on our common denominators.
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Affiliation(s)
- Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Joni M Brady
- International Collaboration of PeriAnaesthesia Nurses (ICPAN) Chair, Alexandria, VA
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Min A, Min H, Hong HC. Work schedule characteristics and fatigue among rotating shift nurses in hospital setting: An integrative review. J Nurs Manag 2019; 27:884-895. [PMID: 30737987 DOI: 10.1111/jonm.12756] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
AIM To systematically evaluate the effect of work schedule characteristics on fatigue among shift nurses in hospital settings. BACKGROUND The complexity and multidimensional nature of nursing work may lead to fatigue. This review mainly focused on work schedule characteristics that may mitigate the fatigue in nurses. EVALUATION Six databases were searched, and eight relevant research articles published between 2000 and 2018 were identified. KEY ISSUES The reviewed articles provided evidence supporting the association of work schedule characteristics such as total working hours, overtime, shift length and number of monthly night and evening shifts with fatigue. In addition, studies provided evidence for the positive association between insufficient rest period between shifts and fatigue among shift nurses in hospital settings. CONCLUSION The reviewed studies provided mixed results regarding the associations between work schedule characteristics and nurse fatigue. However, quick returns and days called to work on days off were consistent factors contributing to nurse fatigue. More evidence is needed to arrive at a definitive conclusion about such relationships. IMPLICATION FOR NURSING MANAGEMENT Nursing managers and administrators need to carefully review current rotating shift system and examine its impact on nurse fatigue as well as ensure enough resting time when developing nurse schedules.
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Affiliation(s)
- Ari Min
- Chung-Ang University Red Cross College of Nursing, Dongjak-gu, Seoul, South Korea
| | - Haeyoung Min
- Gyeongsang National University, College of Nursing, Jinju, South Gyeongsang Province, South Korea
| | - Hye Chong Hong
- Chung-Ang University Red Cross College of Nursing, Dongjak-gu, Seoul, South Korea
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Ciğerci Y, Kısacık ÖG, Özyürek P, Çevik C. Nursing music intervention: A systematic mapping study. Complement Ther Clin Pract 2019; 35:109-120. [DOI: 10.1016/j.ctcp.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 01/09/2023]
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Xuan X, Li Z, Chen X. An Empirical Examination of Nursing Units in China Based on Nurse Experience. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:108-123. [PMID: 29986621 DOI: 10.1177/1937586718786126] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: To create opportunities to increase nursing staff's satisfaction and operational efficiency and eventually improve nurses' experiences through better design in unit layout. BACKGROUND: The majority of research performed on nursing units in China only focused on the spatial design itself, and few studies examined the nursing unit empirically based on nurses' experience. Nursing units need to be designed with understanding nurses' behavior and experience in China. METHOD: A mixed-method approach was conducted in four double-corridor nursing units in China. Observation and interview data were collected to explore how physical environments for managing administrative duties, medications, and caring patient were used in nursing units. RESULTS: The most frequent activities were communication, medication, and patient-care activities. The places in which nurses spent the most of theirs working times were the nurse station (NS), patient room, workstation on wheels (WoW), and medication room. The important clinical work spaces were the patient room, NS, WoW, medication room, doctor's office, disposal room, examining room, and back corridor. The important traffic linkages were between NS and medication room, patient room and WoW, and medication room and patient room. CONCLUSIONS: This article revealed the frequency of nurse activities; how they spent their time; how they use the clinical spaces; identified important clinical spaces, linkages, and driver of inefficiency in nursing work and nursing unit design; and finally generated recommendations for double-corridor nursing unit design in China which can be used by medical planner, hospital administrator.
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Affiliation(s)
- Xiaodong Xuan
- 1 Department of Architecture, College of Architecture and Art, Hefei University of Technology, Hefei, China
| | - Zongfei Li
- 1 Department of Architecture, College of Architecture and Art, Hefei University of Technology, Hefei, China
| | - Xixi Chen
- 1 Department of Architecture, College of Architecture and Art, Hefei University of Technology, Hefei, China
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Hospital Nurses' Work Activity in a Technology-Rich Environment: A Triangulated Quality Improvement Assessment. J Nurs Care Qual 2017; 32:208-217. [PMID: 28541263 DOI: 10.1097/ncq.0000000000000237] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this project was to describe hospital nurses' work activity through observations, nurses' perceptions of time spent on tasks, and electronic health record time stamps. Nurses' attitudes toward technology and patients' perceptions and satisfaction with nurses' time at the bedside were also examined. Activities most frequently observed included documenting in and reviewing the electronic health record. Nurses' perceptions of time differed significantly from observations, and most patients rated their satisfaction with nursing time as excellent or good.
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Sagherian K, Clinton ME, Abu-Saad Huijer H, Geiger-Brown J. Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses. Workplace Health Saf 2016; 65:304-312. [DOI: 10.1177/2165079916665398] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.
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Carayon P, Kianfar S, Li Y, Xie A, Alyousef B, Wooldridge A. A systematic review of mixed methods research on human factors and ergonomics in health care. APPLIED ERGONOMICS 2015; 51:291-321. [PMID: 26154228 PMCID: PMC4725322 DOI: 10.1016/j.apergo.2015.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 05/20/2023]
Abstract
This systematic literature review provides information on the use of mixed methods research in human factors and ergonomics (HFE) research in health care. Using the PRISMA methodology, we searched four databases (PubMed, PsycInfo, Web of Science, and Engineering Village) for studies that met the following inclusion criteria: (1) field study in health care, (2) mixing of qualitative and quantitative data, (3) HFE issues, and (4) empirical evidence. Using an iterative and collaborative process supported by a structured data collection form, the six authors identified a total of 58 studies that primarily address HFE issues in health information technology (e.g., usability) and in the work of healthcare workers. About two-thirds of the mixed methods studies used the convergent parallel study design where quantitative and qualitative data were collected simultaneously. A variety of methods were used for collecting data, including interview, survey and observation. The most frequent combination involved interview for qualitative data and survey for quantitative data. The use of mixed methods in healthcare HFE research has increased over time. However, increasing attention should be paid to the formal literature on mixed methods research to enhance the depth and breadth of this research.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement and Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA.
| | - Sarah Kianfar
- Center for Quality and Productivity Improvement and Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA
| | - Yaqiong Li
- Center for Quality and Productivity Improvement and Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA
| | - Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, USA
| | | | - Abigail Wooldridge
- Center for Quality and Productivity Improvement and Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA
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Sir MY, Dundar B, Barker Steege LM, Pasupathy KS. Nurse–patient assignment models considering patient acuity metrics and nurses’ perceived workload. J Biomed Inform 2015; 55:237-48. [DOI: 10.1016/j.jbi.2015.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/20/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022]
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Sheena J, Jessica H, Regina M, Rose W, Fraser L, Ruth L, Martha M, Moses B, Ellen M. Using a task analysis to strengthen nursing and midwifery pre-service education in Malawi. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ijnm2015.0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Nanda U, Pati S, Nejati A. Field Research and Parametric Analysis in a Medical-Surgical Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 8:41-57. [PMID: 25858106 DOI: 10.1177/1937586715577370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the workplace in a medical-surgical (med-surg) unit and to identify suboptimal environmental conditions that can be improved in the current unit and avoided in future design, through rapidly deployed field research and timely simulation. BACKGROUND Literature emphasizes the importance of the healthcare workplace and the effect on patient outcomes. What is lacking are studies conducted on-site and used for immediate application in design to assess and improve workplace conditions. METHODS A rapidly deployed field research and simulation study was conducted in a 40-bed med-surg unit of a large healthcare system as part of the process of designing a new medical tower. Online surveys, systematic behavioral observations, semi-structured interviews, sound studies, and advanced spatial analysis through parametric modeling were conducted. RESULTS The following created challenges for patient monitoring, care coordination, and management: (1) waste and variability in walking, (2) limited point-of-use access to supplies, (3) large distances traveled for minor tasks, and (4) low visibility and connectivity. The corridor is used as a workspace/communication hub. There is a distinct difference in beginning of day and night shift patterns and between walking "distance" and walking "sequence." There is a tendency for nurses to multitask, but a simulation exercise shows that for key tasks like medication delivery, multitasking may not always reduce walking distances. CONCLUSION Co-location of medications, supplies, and nourishment; accommodation for work on wheels; and spatial and technological connectivity between care team and patients should be considered while designing a med-surg unit. Understanding the key activity sequences helps determine the proximity of spaces in relationship to patient rooms and each other.
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Affiliation(s)
- Upali Nanda
- HKS Inc., Houston, TX, USA Center for Advanced Design Research and Evaluation (CADRE), Dallas, TX, USA
| | - Sipra Pati
- Center for Advanced Design Research and Evaluation (CADRE), Dallas, TX, USA
| | - Adeleh Nejati
- HKS Inc., Houston, TX, USA Texas A & M University, College Station, TX, USA
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Abstract
With climate change threatening the very existence of our species, it is imperative the scientific community collaborate to help solve environmental problems. Human factors professionals are uniquely qualified for addressing issues of climate change, particularly because the potential consequences represent the most human-centric of all concerns. That is, when designing for sustainability, and thus for the preservation of our species, we are designing with the human in mind. However, without a user-centered design, many sustainable products and features may either fail to be adopted or may not be used in a way that maximizes performance, thus limiting their utility and potential benefits. One area of sustainable development that could greatly benefit from improvements in usability is the realm of “green” and LEED-certified building. However, in order to provide improvements in this area, there are a variety of issues and considerations that must be first addressed. In this paper, we provide an overview of each of these areas of concern within green building, describe what is currently being done to solve these issues, and provide human-factors-based solutions to increase usability, performance, and satisfaction within the realm of green building.
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Douglas S, Cartmill R, Brown R, Hoonakker P, Slagle J, Schultz Van Roy K, Walker JM, Weinger M, Wetterneck T, Carayon P. The work of adult and pediatric intensive care unit nurses. Nurs Res 2013; 62:50-8. [PMID: 23222843 DOI: 10.1097/nnr.0b013e318270714b] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Researchers have used various methods to describe and quantify the work of nurses. Many of these studies were focused on nursing in general care settings; therefore, less is known about the unique work nurses perform in intensive care units (ICUs). OBJECTIVES The aim of this study was to observe adult and pediatric ICU nurses in order to quantify and compare the duration and frequency of nursing tasks across four ICUs as well as within two discrete workflows: nurse handoffs at shift change and patient interdisciplinary rounds. METHODS A behavioral task analysis of adult and pediatric nurses was used to allow unobtrusive, real-time observation. A total of 147 hours of observation were conducted in an adult medical-surgical, a cardiac, a pediatric, and a neonatal ICU at one rural, tertiary care community teaching hospital. RESULTS Over 75% of ICU nurses' time was spent on patient care activities. Approximately 50% of this time was spent on direct patient care, over 20% on care coordination, 28% on nonpatient care, and approximately 2% on indirect patient care activities. Variations were observed between units; for example, nurses in the two adult units spent more time using monitors and devices. A high rate and variety of tasks were also observed: Nurses performed about 125 activities per hour, averaging a switch between tasks every 29 seconds. DISCUSSION This study provides useful information about how nurses spend their time in various ICUs. The methodology can be used in future research to examine changes in work related to, for example, implementation of health information technology.
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Affiliation(s)
- Stephen Douglas
- University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
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Alnanih R, Ormandjieva O, Radhakrishnan T. Context-based and Rule-based Adaptation of Mobile User Interfaces in mHealth. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.procs.2013.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Abstract
OBJECTIVE : This project describes the development and testing of the actual scope of nursing practice questionnaire. BACKGROUND : Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope. METHODS : Literature review, expert consultation, and face validity testing were used in item development. The instrument was tested with 285 nurses in 22 medical units in 11 hospitals in Canada. RESULTS : The 26-item, 6-dimension questionnaire demonstrated validity and reliability. The responses suggest that nurses practice at less than their optimal scope, with key dimensions of professional practice being implemented infrequently. CONCLUSIONS : This instrument can help nurse leaders increase the effective use of RN time in carrying out the full scope of their professional practice.
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Alnanih R, Radhakrishnan T, Ormandjieva O. Characterising Context for Mobile User Interfaces in Health Care Applications. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.procs.2012.06.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wetterneck TB, Lapin JA, Krueger DJ, Holman GT, Beasley JW, Karsh BT. Development of a primary care physician task list to evaluate clinic visit workflow. BMJ Qual Saf 2011; 21:47-53. [PMID: 21896667 DOI: 10.1136/bmjqs-2011-000067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Interventions designed to improve the delivery of primary care, including Patient-Centered Medical Homes and electronic health records, require an understanding of clinical workflow to be successfully implemented. However, there is a lack of tools to describe and study primary care physician workflow. We developed a comprehensive list of primary care physician tasks that occur during a face-to-face patient visit. METHODS A validated list of tasks performed by primary care physicians during patient clinic visits was developed from a secondary data analysis of observation data from two studies evaluating primary care workflow. Thirty primary care physicians participated from a convenience sample of 17 internal medicine and family medicine clinics in Wisconsin and Iowa across rural and urban settings and community and academic settings. RESULTS The final task list has 12 major tasks, 189 subtasks, and 191 total tasks. The major tasks are: Enter Room, Gather Information from Patient, Review Patient Information, Document Patient Information, Perform, Recommend / Discuss Treatment Options, Look Up, Order, Communicate, Print / Give Patient (advice, instructions), Appointment Wrap-up, and Leave Room. Additional subcodes note use of paper or EHR and the presence of a caregiver or medical student. CONCLUSIONS The task list presented here is a tool that will help clinics study their workflows so they can plan for changes that will take place because of EHR implementation and/or transformation to a patient centered medical home.
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Affiliation(s)
- Tosha B Wetterneck
- Division of General Internal Medicine, UW School of Medicine and Public Health, 310 North Midvale Blvd., Madison, WI 53705, USA.
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