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Krüger L, Zittermann A, Mannebach T, Wefer F, Becker T, Lohmeier S, Lüttermann A, von Dossow V, Rojas SV, Gummert J, Langer G. Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay. Intensive Crit Care Nurs 2024; 84:103748. [PMID: 38875775 DOI: 10.1016/j.iccn.2024.103748] [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] [Received: 01/30/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care. RESEARCH METHODOLOGY Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge. Recruitment period was one year. SETTING Two intensive care units at a university hospital specialized in cardiovascular and diabetic diseases. MAIN OUTCOME MEASURES Primary outcomes were recruitment and delivery rate. Primary clinical outcome was duration of delirium, as assessed by the Confusion Assessment Method for Intensive Care Units. Secondary outcomes included the incidence of delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of patient relatives (validated questionnaire). RESULTS Of 369 patients screened, 269 could be allocated to primary nursing (n = 134) or standard care (n = 135), of whom 46 patients and 48 patients, respectively, underwent an intensive care unit stay ≥ 3 days. Thus, recruitment and delivery rates were 73 and 26 %, respectively. During primary nursing and standard care, 18 and 24 patients developed a delirium, with a median duration of 32 (IQR: 14-96) and 24 (IQR: 8-44) hours (P = 0.10). The risk difference of delirium for primary nursing versus standard care was 11 % and the relative risk was 0.65 (95 % CI: 0.28-1.46; P = 0.29). The extent of anxiety was similar between groups (P = 0.13). Satisfaction could be assessed in 73.5 % of relatives, without substantial differences between groups. CONCLUSION Data demonstrate that a trial for comparing primary nursing with standard care is generally feasible. However, the incidence of delirium may be a better primary outcome parameter than delirium duration, both in terms of long-term patient outcome and robustness of data quality. IMPLICATIONS FOR CLINICAL PRACTICE A randomized clinical trial regarding nursing organization during intensive care unit stay requires detailed planning of patient recruitment, data evaluation, and power calculation.
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Affiliation(s)
- Lars Krüger
- Project and Knowledge Management/Care Development Intensive Care, Care Directorate, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany.
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Thomas Mannebach
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany; Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne, Germany
| | - Tobias Becker
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Sarah Lohmeier
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Anna Lüttermann
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Gero Langer
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle (Saale), Germany
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Ishii K, Takemura Y, Kida R. Relationship among group learning, individuals' and groups' internalization of evidence-based practice, and nurses' sustainment of the practice: a cross-sectional study. J Health Organ Manag 2024; 38:705-723. [PMID: 39008091 DOI: 10.1108/jhom-04-2023-0096] [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: 07/16/2024]
Abstract
PURPOSE This study, by applying the feedback process of the organizational learning model, examined the relationships among group learning, individuals' and groups' internalization of institutionalized evidence-based practice (I-EBP), and nurses' sustainment of I-EBP. DESIGN/METHODOLOGY/APPROACH Twelve hospitals were included in this cross-sectional study, with 1,741 nurses from 59 wards. Anonymous questionnaires were administered from October to December 2021. Participants self-reported their wards' group learning, internalization of I-EBP, sustainment of I-EBP, EBP beliefs, intra-hospital transfers, and nursing research experiences. The number of nurses and I-EBP introduction length and type of I-EBP were assessed. Internalization of I-EBP of nurses and groups was considered the mediating variable, while group learning and nurses' sustainment of I-EBP were the independent and dependent variables, respectively. Significant variables in bivariate analyses were used as control variables. Multi-level Mediation Analysis and a significance test of indirect effect using the bootstrap method were conducted. FINDINGS Responses from 360 nurses in 48 wards from 12 hospitals were analyzed. Groups' internalization of I-EBP significantly mediated the relationship between group learning and nurses' sustainment of I-EBP. In contrast, no significant mediating effect of nurses' internalization of I-EBP was observed. ORIGINALITY/VALUE In the feedback process of organizational learning, group learning and its subsequent effects on individuals and groups have not been previously examined. Regardless of the nurses' degree of internalization of I-EBP, those who belong to the ward with a high degree of internalization of I-EBP are more likely to sustain it. Conducting group learning may prevent superficial practice, resulting in its sustainability.
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Affiliation(s)
- Keiko Ishii
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukie Takemura
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryohei Kida
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Conti A, Gonella S, Berardinelli D, Dimonte V, Campagna S. Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study. J Adv Nurs 2024. [PMID: 38967383 DOI: 10.1111/jan.16315] [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] [Received: 12/17/2023] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
AIM To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. DESIGN Mixed-methods explanatory sequential. METHODS In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. RESULTS Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. CONCLUSION Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. IMPACT This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. REPORTING METHODS MMR checklist. PATIENT/PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
- Department of Nursing and Allied Health Professions, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
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Elendu C, Amaechi DC, Okatta AU, Amaechi EC, Elendu TC, Ezeh CP, Elendu ID. The impact of simulation-based training in medical education: A review. Medicine (Baltimore) 2024; 103:e38813. [PMID: 38968472 PMCID: PMC11224887 DOI: 10.1097/md.0000000000038813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.
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Tate K, Penconek T, Booth A, Harvey G, Flynn R, Lalleman P, Wolbers I, Hoben M, Estabrooks CA, Cummings GG. Contextually appropriate nurse staffing models: a realist review protocol. BMJ Open 2024; 14:e082883. [PMID: 38719308 PMCID: PMC11086385 DOI: 10.1136/bmjopen-2023-082883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Health Care Aides. Systematic reviews have examined relationships between specific nurse staffing models and client, staff and health system outcomes (eg, mortality, adverse events, retention, healthcare costs), with inconclusive or contradictory results. No evidence has been synthesised and consolidated on how, why and under what contexts certain staffing models produce different outcomes. We aim to describe how we will (1) conduct a realist review to determine how nurse staffing models produce different client, staff and health system outcomes, in which contexts and through what mechanisms and (2) coproduce recommendations with decision-makers to guide future research and implementation of nurse staffing models. METHODS AND ANALYSIS Using an integrated knowledge translation approach with researchers and decision-makers as partners, we are conducting a three-phase realist review. In this protocol, we report on the final two phases of this realist review. We will use Citation tracking, tracing Lead authors, identifying Unpublished materials, Google Scholar searching, Theory tracking, ancestry searching for Early examples, and follow-up of Related projects (CLUSTER) searching, specifically designed for realist searches as the review progresses. We will search empirical evidence to test identified programme theories and engage stakeholders to contextualise findings, finalise programme theories document our search processes as per established realist review methods. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Health Research Ethics Board of the University of Alberta (Study ID Pro00100425). We will disseminate the findings through peer-reviewed publications, national and international conference presentations, regional briefing sessions, webinars and lay summary.
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Affiliation(s)
- Kaitlyn Tate
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tatiana Penconek
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Booth
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Flynn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Inge Wolbers
- University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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McGillis Hall L, Reali V, Canzian S, Johnston L, Hatcher C, Hayward-Murray K, Layton M, Merkley J, Richards J, Taggar R, Woollard S. Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study. BMJ Open Qual 2023; 12:e002353. [PMID: 38135301 DOI: 10.1136/bmjoq-2023-002353] [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] [Received: 03/21/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic. METHODS We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data. RESULTS Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models. CONCLUSION The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.
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Affiliation(s)
| | - Vanessa Reali
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Linda Johnston
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Mikki Layton
- Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Joy Richards
- University Health Network, Toronto, Ontario, Canada
| | - Ru Taggar
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Rattanaprom P, Ratinthorn A, Sindhu S, Viwatwongkasem C. Contributing factors of birth asphyxia in Thailand: a case-control study. BMC Pregnancy Childbirth 2023; 23:584. [PMID: 37582743 PMCID: PMC10426058 DOI: 10.1186/s12884-023-05885-y] [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] [Received: 08/23/2022] [Accepted: 07/30/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. METHODS A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. RESULTS The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. CONCLUSION Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.
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Affiliation(s)
- Panida Rattanaprom
- Doctoral Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Siriorn Sindhu
- Faculty of Nursing, Mahidol University, Bangkok, 10700 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
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Cocchieri A, Cesare M, Anderson G, Zega M, Damiani G, D'agostino F. Effectiveness of the Primary Nursing Model on nursing documentation accuracy: A quasi-experimental study. J Clin Nurs 2023; 32:1251-1261. [PMID: 35253297 DOI: 10.1111/jocn.16282] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To analyse the Primary Nursing Model's effect on nursing documentation accuracy. BACKGROUND The Primary Nursing is widely implemented since it has been considered as the ideal model of care delivery based on the relationship between the nurse and patient. However, previous research has not examined the relationship between Primary Nursing and nursing documentation accuracy. DESIGN A pretest-posttest-follow-up design was used. METHODS The study was conducted from August 2018 to February 2020 in eight surgical and medical wards in an Italian university hospital. The Primary Nursing was implemented in four wards (study group), while in the other four, the Team Nursing was practised (control group). Nursing documentation accuracy was evaluated through the D-Catch instrument. From the eight wards, 120 nursing documentations were selected randomly for each time point (pre-test, post-test and follow-up) and in each group. Altogether, 720 nursing documents were assessed. The study adhered to the TREND checklist. RESULTS The Primary Nursing and Team Nursing Models exhibited significant differences in mean scores for documentation accuracy: assessment on admission, nursing diagnosis, nursing intervention and patient outcome accuracy. No differences between the two groups were found for record structure accuracy and legibility between the posttest and follow-up. CONCLUSION Primary Nursing exerts an overall positive effect on nursing documentation accuracy and persists over time. RELEVANCE TO CLINICAL PRACTICE The benefits from Primary Nursing implementation included better-documented patient outcomes. The use of Primary Nursing linked with the use of the nursing process allowed for a more individualised and problem-solving approach. Nurse managers should consider the implementation of Primary Nursing to improve care quality.
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Affiliation(s)
- Antonello Cocchieri
- Section of Hygiene, Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuele Cesare
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Gloria Anderson
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Maurizio Zega
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gianfranco Damiani
- Section of Hygiene, Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio D'agostino
- Saint Camillus International, University of Health Sciences, Rome, Italy
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Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e254. [PMID: 36626236 DOI: 10.1097/jnr.0000000000000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. PURPOSE This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. METHODS A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. RESULTS Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.
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Siegel EO, Kolanowski AM, Bowers BJ. A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models. Res Gerontol Nurs 2023; 16:5-13. [PMID: 36692436 DOI: 10.3928/19404921-20230104-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].
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Abstract
ABSTRACT The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.
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Feasibility of supporting newly qualified nurses: Nominal group technique of the perspectives of nursing stakeholders. Collegian 2022. [DOI: 10.1016/j.colegn.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dellafiore F, Caruso R, Nania T, Pittella F, Fiorini T, Caruso MP, Zaffino G, Stievano A, Arrigoni C. Does the Synergy Model Implementation Improve the Transition from In-Hospital to Primary Care? The Experience from an Italian Cardiac Surgery Unit, Perspectives, and Future Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5624. [PMID: 35565012 PMCID: PMC9105911 DOI: 10.3390/ijerph19095624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
Abstract
The demand for care services in the healthcare system has changed and is triggering a smooth transition from in-hospital to primary care. In this regard, patient-centered-care models of care delivery might provide a framework to follow patients' journeys throughout their transition between different levels of care. Accordingly, an Italian research group at a cardiac hospital in Northern Italy implemented the Synergy Model in a Cardiac Surgery Unit, a patient-centered-care model, and is using the framework of the model to guide a smooth transition of patients towards rehabilitation and primary care after their hospitalization. This discursive paper is focused on the experience, perspectives, and future implications of adopting the Synergy Model to facilitate the transition from in-hospital to primary care. The presented experience and discussion might be helpful to the international debate regarding the strategies to boost a smooth transition from in-hospital to primary care.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy; (F.D.); (C.A.)
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
| | - Tiziana Fiorini
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
| | - Maria Paola Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
| | - Giovanni Zaffino
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (R.C.); (F.P.); (T.F.); (M.P.C.); (G.Z.)
| | | | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy; (F.D.); (C.A.)
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Nursing Leadership – Transforming the Work Environment in Nursing Homes. Nurs Clin North Am 2022; 57:299-314. [DOI: 10.1016/j.cnur.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jones KL, Johnson MR, Lehnertz AY, Kramer RR, Drilling KE, Bungum LD, Bell SJ. Rapid Deployment of Team Nursing During a Pandemic: Implementation Strategies and Lessons Learned. Crit Care Nurse 2022; 42:27-36. [PMID: 35322267 DOI: 10.4037/ccn2022399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The COVID-19 pandemic increased the number of patients requiring intensive care nationwide, leading to nurse staffing shortages in many units. LOCAL PROBLEM At the beginning of the statewide COVID-19 surge, a tertiary teaching hospital in the upper Midwest experienced a sharp increase in patients needing intensive care. To relieve the resulting staffing shortage, it implemented a pilot program to bring general care nurses into its 21-bed mixed specialty intensive care unit to free intensive care unit nurses to help staff the hospital's COVID-designated units. METHODS Using a team nursing model, the intensive care unit recruited, oriented, and incorporated 13 general care nurses within 4 days. Education and resources were developed to distinguish team nurses from intensive care unit nurses, introduce them to the intensive care unit environment, outline expectations, communicate between team nursing pairs, and guide charge nurses in making staffing decisions and assignments. Staff feedback identified additional resources, barriers, and successes. An adaptive process was used to improve and update tools and resources on the basis of staff needs. RESULTS The pilot program ran for 6 weeks. Positive outcomes included a reduced need for float nurses and self-perceived reduction in nursing workload. The principal barrier was charge nurses' challenges involving staffing-to-workload balance based on the existing staffing model. This model identified productivity of a general care nurse and an intensive care unit nurse as equivalent, despite differences in their skill sets. CONCLUSION Team nursing in the intensive care unit is an agile tactic easily replicated in dire staffing situations.
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Affiliation(s)
- Kelly L Jones
- Kelly L. Jones is a nursing education specialist, medical/surgical/transplant intensive care unit/progressive care unit, Mayo Clinic, Rochester, Minnesota
| | - Maren R Johnson
- Maren R. Johnson is a nurse manager, medical/surgical/transplant intensive care unit/progressive care unit, Mayo Clinic
| | - Andrea Y Lehnertz
- Andrea Y. Lehnertz is a clinical nurse specialist for the medical/surgical/transplant intensive care unit/progressive care unit, the code blue and rapid response teams, and the enhanced critical care unit, Mayo Clinic
| | - Robert R Kramer
- Robert R. Kramer is a nurse manager of an orthopedic general care unit, Mayo Clinic
| | - Kelly E Drilling
- Kelly E. Drilling is a nurse manager of an orthopedic general care unit, Mayo Clinic
| | - Lisa D Bungum
- Lisa D. Bungum is a nurse administrator for medical/surgical intensive care units, pulmonology, and the sleep clinic, Mayo Clinic
| | - Sarah J Bell
- Sarah J. Bell is a nurse administrator, Center for Digital Health and Orthopedics, Mayo Clinic
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Abusamra A, Rayan AH, Obeidat RF, Hamaideh SH, Baqeas MH, ALBashtawy M. The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses. SAGE Open Nurs 2022; 8:23779608221124292. [PMID: 36081492 PMCID: PMC9445452 DOI: 10.1177/23779608221124292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Inappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses’ health, but also the health of their patients. Purpose To examine the relationship between nursing care delivery models, nurses’ emotional exhaustion, and quality of nursing care. Methods A cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care. Results Participants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = −.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = −8.98, P = .011). Conclusions Quality of nursing care was associated with nurses’ emotional exhaustion rather than models of nursing care delivery. As nurses’ emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.
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Affiliation(s)
| | - Ahmad Hussien Rayan
- Psychiatric and Mental Health Nursing, and Dean, Zarqa University, Zarqa, Jordan
| | - Rana F. Obeidat
- College of Health Sciences, Higher Colleges of Technology, UAE
| | - Shaher H. Hamaideh
- Community and Mental Health Nursing Department, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | | | - Mohammed ALBashtawy
- Faculty of Nursing, Community Health Nursing, Al Albayt University, Al-Mafraq, Jordan
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Savva G, Papastavrou E, Charalambous A, Vryonides S, Merkouris A. Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study. Glob Qual Nurs Res 2022; 9:23333936221094857. [PMID: 35782105 PMCID: PMC9243474 DOI: 10.1177/23333936221094857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
A focus group study was conducted to explore nurses' perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses' perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety.
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Affiliation(s)
| | | | - Andreas Charalambous
- Cyprus University of Technology,
Limassol, Republic of Cyprus
- University of Turku,
Finland
| | - Stavros Vryonides
- Cyprus University of Technology,
Limassol, Republic of Cyprus
- State Health Services
Organization, Limassol, Republic of Cyprus
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Cassidy CE, Harrison MB, Godfrey C, Nincic V, Khan PA, Oakley P, Ross-White A, Grantmyre H, Graham ID. Use and effects of implementation strategies for practice guidelines in nursing: a systematic review. Implement Sci 2021; 16:102. [PMID: 34863220 PMCID: PMC8642950 DOI: 10.1186/s13012-021-01165-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. METHODS We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. RESULTS The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. CONCLUSIONS Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.
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Affiliation(s)
- Christine E. Cassidy
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Margaret B. Harrison
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Christina Godfrey
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Patricia Oakley
- National Research Council Canada, Institute for Information Technology, 46 Dineen Drive, Fredericton, NB E3B 9W4 Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, 18 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Hilary Grantmyre
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Ian D. Graham
- School of Epidemiology and Public HealthSchool of Nursing, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
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Khatatbeh H, Zrínyi M, Oláh A, Pakai A. The relationship between paediatric nurses' quality of life and intent to leave: The moderating role of hospital type. Nurs Open 2021; 9:676-683. [PMID: 34730275 PMCID: PMC8685849 DOI: 10.1002/nop2.1116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Different types of hospitals exist in Jordan, and each type has its own leadership style. This might affect the nursing workforce in terms of quality of life and intent to leave. Aim This study aimed at (1) assessing the relationship between paediatric nurses' quality of life and intent to leave, (2) examining the moderating effect of the hospital type on this relationship, (3) comparing the quality of life of paediatric nurses working at ministry of health and the University‐Affiliated hospitals and (4) exploring the determinants of nurses' intent to leave. Design A cross‐sectional, comparative and correlational design was used in this study. Methods A multi‐site sample was selected from two types of hospitals in Jordan; the ministry of health and the University‐Affiliated hospitals. A sample of 225 paediatric nurses responded to the brief quality of life questionnaire by the World Health Organization in addition to a group of sociodemographic and work‐related questions. Results and conclusion Nurses' quality of life and intent to leave were negatively correlated. This correlation was moderated by the type of hospital. Nurses' quality of life was significantly different in the two types of hospitals. Both salary and nursing care model predicted paediatric nurses' intent to leave. The managerial style and work environment of the ministry of health hospitals should be benchmarked against the University‐Affiliated hospitals.
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Affiliation(s)
- Haitham Khatatbeh
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Miklós Zrínyi
- Faculty of Health Sciences, Basic Health Sciences and Health Visiting, Institute of Nursing Sciences, University of Pécs, Pécs, Hungary
| | - András Oláh
- Faculty of Health Sciences, Basic Health Sciences and Health Visiting, Institute of Nursing Sciences, University of Pécs, Pécs, Hungary
| | - Annamária Pakai
- Faculty of Health Sciences, Basic Health Sciences and Health Visiting, Institute of Nursing Sciences, University of Pécs, Pécs, Hungary
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Prentice D, Moore J, Desai Y. Nursing care delivery models and outcomes: A literature review. Nurs Forum 2021; 56:971-979. [PMID: 34418101 DOI: 10.1111/nuf.12640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this literature review was to determine the types of nursing care delivery models currently being used in acute care hospitals to determine the effectiveness of the model and the outcomes being measured. METHOD A literature search was conducted, and databases searched included CINAHL, Nursing and Allied Health, Medline, EMBASE, ProQuest Theses, and Dissertations for the years 2000-2020. Sixteen studies were retrieved. Patient outcomes measured included falls, adverse events, and infections. Nursing outcomes measured included satisfaction, communication, and perceived quality of care. RESULTS Findings from this review showed there was no single model of nursing care delivery that resulted in positive patient or nurse outcomes, thus a "one size fits all" approach to selecting or utilizing a model of care is not realistic. CONCLUSION Given the number of nursing care delivery models that were hybrids, clearer descriptions of each model and further research on patient and nursing outcomes is warranted.
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Affiliation(s)
- Dawn Prentice
- Department of Nursing, Brock University, Ontario, Canada
| | - Jane Moore
- Department of Nursing, Brock University, Ontario, Canada
| | - Yutee Desai
- Department of Nursing, Brock University, Ontario, Canada
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Beckett CD, Zadvinskis IM, Dean J, Iseler J, Powell JM, Buck-Maxwell B. An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19. Worldviews Evid Based Nurs 2021; 18:251-260. [PMID: 34355844 PMCID: PMC8450812 DOI: 10.1111/wvn.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
Background During the COVID‐19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. Purpose To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. Methods We conducted an integrative review of team nursing and delegation using Whittemore and Knafl’s (2005) methodology. Results We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses’ delegation knowledge, decision‐making, and competency. Linking evidence to action Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.
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Affiliation(s)
- Cynthia D Beckett
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Inga M Zadvinskis
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Dean
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Jackeline Iseler
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Julie M Powell
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Betty Buck-Maxwell
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Ahmad MS, Abuzar MA, Razak IA, Rahman SA, Borromeo GL. Oral health education in the undergraduate nursing curriculum of Australian and Malaysian institutions. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:350-359. [PMID: 33021010 DOI: 10.1111/eje.12611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A high degree of training is necessary to prepare student nurses for their roles as oral healthcare partners that can promote a holistic approach to health in the community. This study aims to determine the extent of oral health education in Australian and Malaysian nursing institutions, as well as investigate educators' perceptions of education and practice in this area of care. METHODOLOGY An audio-recorded, semi-structured qualitative phone interview was conducted with the heads of 42 nursing schools across Australia (n = 35) and Malaysia (n = 7) during the 2015 academic year. Qualitative data were analysed via thematic analysis. Quantitative data, wherever appropriate, were measured for frequencies. RESULTS The response rate was 34.2% (n = 12) and 71.4% (n = 5) for the Australian and Malaysian subjects, respectively. Findings revealed that although all the nursing schools measured provided didactic and clinical training in oral health, curriculum content, expected learning outcomes, amount of clinical exposure and assessment approach lacked consistency. Most nursing educators across both countries perceived an overloaded curriculum as a barrier to providing oral health education. Whilst educators demonstrated their support for training in this area of care, they expressed the need for an established national guideline that highlights the educational requirement for future nurses in oral health maintenance and their scope of practice. CONCLUSION This study provides valuable information for further developing oral health education for nurses, to improve their competency and ultimately the health of the communities that they will serve.
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Affiliation(s)
- Mas S Ahmad
- Universiti Teknologi MARA, Selangor Branch, Sungai Buloh Campus, Sungai Buloh, Malaysia
| | | | | | - Sabariah A Rahman
- Universiti Teknologi MARA, Selangor Branch, Sungai Buloh Campus, Sungai Buloh, Malaysia
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Parreira P, Santos-Costa P, Neri M, Marques A, Queirós P, Salgueiro-Oliveira A. Work Methods for Nursing Care Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042088. [PMID: 33669955 PMCID: PMC7924841 DOI: 10.3390/ijerph18042088] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.
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Affiliation(s)
- Pedro Parreira
- Enfermagem, Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde, 3004-011 Coimbra, Portugal; (P.Q.); (A.S.-O.)
- Correspondence: (P.P.); (P.S.-C.)
| | - Paulo Santos-Costa
- Enfermagem, Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde, 3004-011 Coimbra, Portugal; (P.Q.); (A.S.-O.)
- Correspondence: (P.P.); (P.S.-C.)
| | - Manoel Neri
- Conselho Federal de Enfermagem (COFEN), Brasília 70736-550, Brazil;
| | - António Marques
- Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal;
| | - Paulo Queirós
- Enfermagem, Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde, 3004-011 Coimbra, Portugal; (P.Q.); (A.S.-O.)
| | - Anabela Salgueiro-Oliveira
- Enfermagem, Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde, 3004-011 Coimbra, Portugal; (P.Q.); (A.S.-O.)
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Abstract
OBJECTIVE The aim of this study was to assess the differences in patient complications as well as patient and staff satisfaction between a mixed-skill unit and an all-registered nurse (RN) unit. BACKGROUND It is recognized that nursing care delivered by RNs results in better outcomes; however, more evidence is needed to support a change to an all-RN unit. METHODS A mixed unit with RNs and unlicensed assistive personnel was compared with an all-RN unit. Each unit had similar resources. Patient complications and patient and staff satisfaction were measured. Patient complications were reported in terms of 1,000 patient days over the study period to minimize noise fluctuations; t test and χ compared means and frequencies, respectively. RESULTS The all-RN unit had a lower prevalence of patient complications. Patients reported better pain management, and nurse explanation, and reported higher satisfaction on the all-RN unit. CONCLUSIONS An all-RN unit provided superior outcomes compared with a mixed-skill unit without additional costs.
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Abstract
Supplemental Digital Content is available in the text. Background: Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices—using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs—are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required. Methods: A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010–2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients’ time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect. Results: Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002–1.017; P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965–0.995, P=0.008). RN experience and skill mix were not significantly associated with mortality. Conclusion: Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.
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Otter CEM, Smit J, Hagedoorn EI, Keers JC, de Man-van Ginkel JM, Schoonhoven L. Nurses' perceptions of self-management and self-management support of older patients during hospitalization. Geriatr Nurs 2020; 42:159-166. [PMID: 32798001 DOI: 10.1016/j.gerinurse.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
Four focus group interviews were held with nurses, recruited from eight wards of two general hospitals, to explore nurses' perceptions of self-management and self-management support of older patients during hospitalization. A thematic analyze of the interview transcripts was conducted. Regarding nurses understanding of self-management two perceptions emerged namely 'being self-reliant' and 'being in control'. In terms of their understanding self-management support three perceptions emerged: encouraging patients to perform activities of daily living (ADL); stimulating patient participation; and increasing patients' awareness. We also found seven themes relating to nurses' beliefs regarding older patients' self-management and self-management support during hospitalization. Results indicate that nurses have a limited understanding of self-management and do not fully understand what is expected from them with regards to inpatients' self-management. It is feasible to argue that addressing nurses' beliefs can influence nurses intention and behavior regarding supporting older inpatients' self-management.
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Affiliation(s)
- Caroline E M Otter
- Martini Hospital, Van Swietenlaan 1, Groningen, NT 9728, the Netherlands.
| | - Jakobus Smit
- University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, the Netherlands.
| | - Ellen I Hagedoorn
- Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, CA 9714, the Netherlands.
| | - Joost C Keers
- Martini Hospital, Van Swietenlaan 1, Groningen, NT 9728, the Netherlands; Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, CA 9714, the Netherlands.
| | - Janneke M de Man-van Ginkel
- Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 7132, Heidelberglaan 100, Utrecht, CX 3584, the Netherlands.
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 7132, Heidelberglaan 100, Utrecht, CX 3584, the Netherlands.
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Rees CS, Eley R, Osseiran-Moisson R, Francis K, Cusack L, Heritage B, Hegney D. Individual and environmental determinants of burnout among nurses. J Health Serv Res Policy 2020; 24:191-200. [PMID: 31291766 DOI: 10.1177/1355819619840373] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Burnout is a significant problem affecting the nursing workforce and is associated with significant personal suffering and high rates of nurse turnover. Efforts to further understand the variables that explain burnout are needed. The aim of this cross-sectional study was to examine both environmental and individual factors that may explain burnout among nurses. Method We recruited 1848 Australian nurses to complete several online questionnaires measuring the practice environment (Practice Environment Scale of the Nursing Work Index), burnout (Professional Quality of Life Scale), trait negative affect ( Spielberger State-Trait Anxiety Inventory form Y2) and resilience (Connor Davidson Resilience Scale). Correlational analysis as well as hierarchical regression was used to determine the relative importance of variables in explaining burnout scores. Results All of the practice environment scales were significantly related to burnout in the negative direction, and these relationships were above .3 for all except the relationship scale ( r = –.256) and the participation in hospital affairs scale ( r = –.285). Overall, the regression model accounted for 62% of the variance in nurse burnout scores. Trait negative affect, resilience and two aspects of practice environment (Manager sub-scale and Staffing sub-scale) all explained significant variance in burnout scores. The largest contribution came from the two individual variables (resilience and trait negative affect) that together explained 55% of the variance in burnout scores. Conclusions Findings suggest that health service administrators should provide nursing staff with education and support to build individual resilience. Workplaces that attend to staffing and resource issues and have managers who provide high levels of support to their staff appear to be essential strategies to help prevent nurse burnout.
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Affiliation(s)
- Clare S Rees
- 1 Professor of Clinical Psychology, School of Psychology, Faculty of Health Sciences, Curtin University, Australia
| | - Robert Eley
- 2 Director (Research Training), Faculty of Medicine, University of Queensland, Australia
| | | | - Karen Francis
- 4 Professor, School of Nursing Midwifery and Paramedicine, Australian Catholic University, Australia
| | - Lynette Cusack
- 5 Associate Professor Nursing, Adelaide Nursing School, The University of Adelaide, Australia
| | - Brody Heritage
- 6 Lecturer in Organisational Psychology, School of Psychology and Exercise Science, Murdoch University, Australia
| | - Desley Hegney
- 7 Professorial Research Fellow, Research Division, Central Queensland University, Brisbane.,8 Adjunct Professor of Nursing, University of Adelaide, Australia
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Kilpatrick K, Tchouaket É, Jabbour M, Hains S. A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities. BMC Nurs 2020; 19:6. [PMID: 32015689 PMCID: PMC6990528 DOI: 10.1186/s12912-019-0395-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. METHODS Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. RESULTS Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. CONCLUSIONS The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
| | - Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada
| | | | - Sylvie Hains
- Retired, Ministère de la Santé et des services sociaux du Québec, Québec, Canada
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Barriers and Enablers to Implementing a High-Dependency Care Model in Pediatric Care: A Preimplementation Study. J Nurs Care Qual 2019; 34:370-375. [PMID: 30889080 DOI: 10.1097/ncq.0000000000000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the level of acuity of pediatric hospital admissions continues to increase, additional pressure is being placed on hospital resources and the nursing workforce. LOCAL PROBLEM Currently, there is no formalized approach to care for high-acuity patients on our pediatric inpatient unit. METHODS We used a qualitative descriptive design, guided by the Theoretical Domains Framework and Capability, Opportunity, Motivation-Behaviour (COM-B) model, to conduct focus groups and interviews with clinicians and administrators to identify potential barriers and enablers to implementing a high-dependency care (HDC) model. An HDC model focuses on the relationship between adequate nursing staff resources and patient acuity to improve patient health outcomes. RESULTS Participants identified the need for clear guidelines and supportive physical structures to facilitate HDC implementation. Anticipated benefits included enhanced nursing confidence and family-centered care. CONCLUSIONS Study findings highlight multilevel factors to consider prior to implementing an HDC model on a pediatric inpatient unit.
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Gunawan NPIN, Hariyati RTS, Gayatri D. Motivation as a factor affecting nurse performance in Regional General Hospitals: A factors analysis. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Havaei F, Dahinten VS, MacPhee M. Effect of Nursing Care Delivery Models on Registered Nurse Outcomes. SAGE Open Nurs 2019; 5:2377960819869088. [PMID: 33415250 PMCID: PMC7774368 DOI: 10.1177/2377960819869088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/08/2019] [Accepted: 07/20/2019] [Indexed: 12/15/2022] Open
Abstract
The two key components of models of nursing care delivery are mode of nursing
care delivery and skill mix. While mode of nursing care delivery refers to the
independent or collaborative work of nurses to provide care to a group of
patients, skill mix is defined as direct care nurse classifications. Previous
research has typically focused on only one component at a time (mode or skill
mix). There exists little research that investigates both components
simultaneously. This study examined the effect of mode of nursing care delivery
and skill mix on nurse emotional exhaustion and job satisfaction after
controlling for nurse demographics, workload factors, and work environment
factors. A secondary analysis was done with survey data from 416 British
Columbia medical–surgical registered nurses. Data were analyzed using
hierarchical multiple regression and moderated regression. Registered nurses in
a skill mix with licensed practical nurses reported lower emotional exhaustion
when caring for more acute patients compared with those in a skill mix without
licensed practical nurses. While mode of nursing care delivery was not related
to nurse outcomes, work environment factors were the strongest predictors of
both nurse outcomes. Skill mix moderated the relationship between patient acuity
and emotional exhaustion. Nurse managers should invest in nurses’ conditions of
work environments.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Havaei F, MacPhee M, Dahinten VS. The effect of nursing care delivery models on quality and safety outcomes of care: A cross-sectional survey study of medical-surgical nurses. J Adv Nurs 2019; 75:2144-2155. [PMID: 30883835 DOI: 10.1111/jan.13997] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/03/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
AIMS This study examined the effect of two components of a model of nursing care delivery, the mode of nursing care delivery, and skill-mix on: (a) quality of nursing care; and (b) patient adverse events, after controlling for nurse demographics, work environment, and workload factors. DESIGN A cross-sectional exploratory correlational study that drew on secondary data was conducted. METHODS Survey data from 416 direct care registered nurses from medical-surgical settings across British Columbia were analysed using hierarchical multiple regression. Larger study data were collected in 2015. RESULTS Nurses working in a team-based mode reported a greater number of nursing tasks left undone compared with those working in a total patient care. Nurses working in a skill-mix with licensed practical nurses reported a higher frequency of patient adverse events compared with those working in a skill-mix without licensed practical nurses. At higher levels of acuity, nurses in a team-based mode reported a higher frequency of patient adverse events than did nurses in a total patient care. CONCLUSION Models of nursing care delivery components, mode and skill-mix, influenced quality and safety outcomes. Some of the team-based medical-surgical nurses in British Columbia are not functioning as effective teams. Team building strategies should be used to enhance collaboration among them. IMPACT Research into redesigning care delivery has typically focused on only one care delivery component at a time. The study findings could have implications for nurses and patients, nursing leadership and policymakers particularly in medical-surgical settings in British Columbia.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Butler M, Schultz TJ, Halligan P, Sheridan A, Kinsman L, Rotter T, Beaumier J, Kelly RG, Drennan J. Hospital nurse-staffing models and patient- and staff-related outcomes. Cochrane Database Syst Rev 2019; 4:CD007019. [PMID: 31012954 PMCID: PMC6478038 DOI: 10.1002/14651858.cd007019.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff-allocation models, staffing levels, nursing shifts, or nurses' work patterns. This is the first update of our review published in 2011. OBJECTIVES The purpose of this review was to explore the effect of hospital nurse-staffing models on patient and staff-related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff-related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. SEARCH METHODS CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series or repeated-measures studies of interventions relating to hospital nurse-staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient-, staff-related, or economic outcome. The most important outcomes included in this review were: nursing-staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. DATA COLLECTION AND ANALYSIS We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. MAIN RESULTS We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse-staffing models:- introduction of advanced or specialist nurses to the nursing workforce;- introduction of nursing assistive personnel to the hospital workforce;- primary nursing; and- staffing models.The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long-stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing-staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. AUTHORS' CONCLUSIONS The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.
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Affiliation(s)
- Michelle Butler
- Dublin City UniversityFaculty of Science and HealthCollins Avenue, GlasnevinDublinIrelandDublin 9
| | - Timothy J Schultz
- University of AdelaideDiscipline of NursingAdelaideSouth AustraliaAustralia
| | - Phil Halligan
- University College DublinSchool of Nursing, Midwifery and Health SystemsDublinIreland
| | - Ann Sheridan
- University College DublinSchool of Nursing, Midwifery and Health SystemsDublinIreland
| | - Leigh Kinsman
- The University of Newcastle and Mid North Coast Local Health DistrictSchool of Nursing and MidwiferyPort MacquarieNew South WalesAustralia2444
| | - Thomas Rotter
- School of Nursing, Queen's UniversityHealthcare Quality Programs82‐84 Barrie StretKingston, OntarioOntarioCanadaK7L 3N6
| | - Jonathan Beaumier
- University of British ColumbiaSchool of Population and Public Health2206 East MallVancouverBCCanadaV6T 1Z3
| | - Robyn Gail Kelly
- University of TasmaniaSchool of Health SciencesLocked Bag 1322NewnhamTasmaniaAustralia7250
| | - Jonathan Drennan
- Brookfield Health Sciences Complex, University College CorkSchool of Nursing and Midwifery, College of Medicine and HealthCollege RoadCorkIrelandT12 AK54
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Naef R, Ernst J, Petry H. Adaption, benefit and quality of care associated with primary nursing in an acute inpatient setting: A cross-sectional descriptive study. J Adv Nurs 2019; 75:2133-2143. [PMID: 30843241 DOI: 10.1111/jan.13995] [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: 09/17/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to investigate the adoption of primary nursing and to determine the quality of primary nurse-led care in an acute inpatient setting. DESIGN Descriptive cross-sectional study. METHODS Participants included inpatients (N = 369) and nurses (N = 381). To assess adoption of primary nursing, patient records were analysed and an online survey of nurses was conducted from May-June 2017. To measure quality of nursing care, a structured questionnaire was administered to inpatients. RESULTS Patients reported high quality of individualized, responsive and proficient care, but lower levels of coordinated care. Most nurses agreed that primary nursing is beneficial for person-centred caring. However, only two-thirds found that it was practiced on their unit and only half of care planning activities were attributable to primary nurses. CONCLUSION While perceived as beneficial, adoption of primary nursing in clinical practice remains partial. Hence, primary nursing may not be enough to ensure continuity and coordination of acute care.
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Affiliation(s)
- Rahel Naef
- Centre for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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McCarley RM, Dowling DA, Dolansky MA, Bieda A. Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project. Neonatal Netw 2018; 37:96-104. [PMID: 29615157 DOI: 10.1891/0730-0832.37.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. CONCLUSION Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.
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Whitehair L, Hurley J, Provost S. Envisioning successful teamwork: An exploratory qualitative study of team processes used by nursing teams in a paediatric hospital unit. J Clin Nurs 2018; 27:4257-4269. [PMID: 29893436 DOI: 10.1111/jocn.14558] [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: 06/03/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how team processes support nursing teams in hospital units during every day work. BACKGROUND Due to their close proximity to patients, nurses are central to the process of maintaining patient safety. Globally, changes in models of care delivery by nurses, inclusive of team nursing are being considered. DESIGN AND METHODS This qualitative study used purposive sampling in a single hospital and participants were nurses employed to work on a paediatric unit. Data were collected using nonparticipant observation. Thematic analysis was used to analyse and code data to create themes. RESULTS Three clear themes emerged. Theme 1: "We are a close knit team"; Behaviours building a successful team - outlines expectations regarding how members are to behave when establishing, nurturing and managing a team. Theme 2: "Onto it"; Ways of interacting with each other - Identifies the expected pattern of relating within the team which contribute to shared understanding and actions. Theme 3: "No point in second guessing"; Maintaining a global view of the unit - focuses on the processes for monitoring and reporting signals that team performance is on course or breaking down and includes accepting responsibility to lead the team and team members having a widespread sensitivity to what needs to happen. CONCLUSION Essential to successful teamwork is the interplay and mutuality of team members and team leaders. RELEVANCE TO CLINICAL PRACTICE Leadership behaviours exhibited in this study provide useful insights to how informal and shared or distributed leadership of teams may be achieved. Without buy-in from team members, teams may not achieve successful desired outcomes. It is not sufficient for teams to rely on current successful outcomes, as they need to be on the look-out for new ways to ensure that they can anticipate possible risks or threats to the team before harm is done.
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Affiliation(s)
- Leeann Whitehair
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Steve Provost
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Lee JY, Song YA, Jung JY, Kim HJ, Kim BR, Do HK, Lim JY. Nurses' needs for care robots in integrated nursing care services. J Adv Nurs 2018; 74:2094-2105. [PMID: 29754395 DOI: 10.1111/jan.13711] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/01/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
AIMS To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in integrated nursing care services. BACKGROUND Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced "integrated nursing care services"; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. DESIGN The study applied a cross-sectional survey. METHODS In 2016, we conducted a multicentre survey involving 302 Registered Nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. RESULTS Trial centre nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top-three desired primary roles for care robots were "measuring/monitoring", "mobility/activity" and "safety care". "Reduction in workload", especially in terms of "other nursing services" which were categorized as nonvalue-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. CONCLUSION Care robots are expected to be effective in integrated nursing care services, particularly in "measuring/monitoring". Such robots should decrease nurses' workload and minimize nonvalue-added nursing activities efficiently. No matter how excellent care robots are, they must cooperate with and be controlled by nurses.
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Affiliation(s)
- Jai-Yon Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- College of Nursing, Seoul National University, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Jung
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jeong Kim
- College of Nursing, Seoul National University, Seoul, Korea
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ram Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Kyung Do
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- Jessica Dickerson
- Jessica Dickerson and Amanda Latina are RN IIIs at Christiana Care Health Services in Newark, Del
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Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, Rada G, Wiysonge CS, Bastías G, Dudley L, Flottorp S, Gagnon M, Garcia Marti S, Glenton C, Okwundu CI, Peñaloza B, Suleman F, Oxman AD. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011083. [PMID: 28901005 PMCID: PMC5621087 DOI: 10.1002/14651858.cd011083.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. AUTHORS' CONCLUSIONS A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies.
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Affiliation(s)
- Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Tomas Pantoja
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | | | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Gabriel Bastías
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Signe Flottorp
- Norwegian Institute of Public HealthDepartment for Evidence SynthesisPO Box 4404 NydalenOsloNorway0403
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Fatima Suleman
- University of KwaZulu‐NatalDiscipline of Pharmaceutical Sciences, School of Health SciencesPrivate Bag X54001DurbanKZNSouth Africa4000
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Occurrence and Duration of Interruptions During Nurses' Work in Surgical Wards: Findings From a Multicenter Observational Study. J Nurs Care Qual 2017; 31:174-82. [PMID: 26447344 DOI: 10.1097/ncq.0000000000000159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This was an observational multicenter study of 50 registered nurses, randomly selected, on 5 surgical wards in 5 Italian hospitals. There were on average 5.6 interruptions per hour. Interruptions occurred more frequently during the afternoon shift (n = 1061; 52.8%), were caused mainly by the staff members (n = 978; 48.7%) during medication administration (n = 1075; 53.5%), and were managed directly by the nurses (n = 1639; 81.6%). The average duration of an interruption was 32.7 seconds (95% confidence interval, 30.7-34.7).
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41
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Lusignani M, Giannì ML, Re LG, Buffon ML. Moral distress among nurses in medical, surgical and intensive-care units. J Nurs Manag 2016; 25:477-485. [PMID: 27726233 DOI: 10.1111/jonm.12431] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
Abstract
AIM To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. BACKGROUND Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. METHODS A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. RESULTS The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. CONCLUSIONS The present study indicates that nurses experience an overall moderate level of moral distress. IMPLICATIONS FOR NURSING MANAGEMENT Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care.
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Affiliation(s)
- Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Giuseppe Re
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Luisa Buffon
- Ospedale Cà Foncello, Azienda ULSS 9, Treviso, Italy.,Provincial College of Nurses, Treviso, Italy
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42
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Murray-Parahi P, DiGiacomo M, Jackson D, Davidson PM. New graduate registered nurse transition into primary health care roles: an integrative literature review. J Clin Nurs 2016; 25:3084-3101. [DOI: 10.1111/jocn.13297] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Pauline Murray-Parahi
- Centre for Cardiac and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
- Liverpool Hospital; South Western Sydney Local Health District; Liverpool NSW Australia
| | - Michelle DiGiacomo
- Centre for Cardiac and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - Debra Jackson
- Oxford Brookes University; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- University of New England
| | - Patricia M Davidson
- Centre for Cardiac and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
- Johns Hopkins School of Nursing; Baltimore MD USA
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43
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King A, Long L, Lisy K. Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care wards: a systematic review. ACTA ACUST UNITED AC 2015; 13:128-68. [DOI: 10.11124/jbisrir-2015-2428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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44
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Havaei F, MacPhee M, Susan Dahinten V. RNs and LPNs: emotional exhaustion and intention to leave. J Nurs Manag 2015; 24:393-9. [DOI: 10.1111/jonm.12334] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Farinaz Havaei
- School of Nursing; University of British Columbia; Vancouver Canada
| | - Maura MacPhee
- School of Nursing; University of British Columbia; Vancouver Canada
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Rantanen A, Pitkänen A, Paimensalo-Karell I, Elovainio M, Aalto P. Two models of nursing practice: a comparative study of motivational characteristics, work satisfaction and stress. J Nurs Manag 2015; 24:261-70. [PMID: 26014618 DOI: 10.1111/jonm.12313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/28/2022]
Abstract
AIM To examine the differences in work-related motivational and stress factors between two nursing allocation models (the primary nursing model and the individual patient allocation model). BACKGROUND A number of nursing allocation models are applied in hospital settings, but little is known about the potential associations between various models and work-related psychosocial profiles in nurses. METHOD A cross-sectional study using an electronic questionnaire. The data were collected from nurses (n = 643) working in 22 wards. In total, 317 questionnaires were returned (response rate 49.3%). RESULTS There were no significant differences in motivational characteristics between the different models. The nurses working according to the individual patient allocation model were more satisfied with their supervisors. The work itself and turnover caused more stress to the nurses working in the primary nursing model, whereas patient-related stress was higher in the individual patient allocation model. CONCLUSION No consistent evidence to support the use of either of these models over the other was found. Both these models have positive and negative features and more comparative research is required on various nursing practice models from different points of view. IMPLICATIONS FOR NURSING MANAGEMENT Nursing directors and ward managers should be aware of the positive and negative features of the various nursing models.
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Affiliation(s)
- Anja Rantanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Anneli Pitkänen
- Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Irmeli Paimensalo-Karell
- Department of Nursing Science, University of Turku, Turku, Finland.,Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Marko Elovainio
- National Institute for Health and Welfare, Helsinki, Finland
| | - Pirjo Aalto
- Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
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46
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The Key Role of Nurse Researchers in the Evaluation of Nurse Practitioner Models of Practice. Res Theory Nurs Pract 2015; 29:214-25. [DOI: 10.1891/1541-6577.29.3.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Nurse Practitioner–Aged Care Models of Practice Program involved diverse models of practice comprising multiple stakeholders located in more than 30 locations across Australia, in remote, rural, urban, and metropolitan settings. Funded by the Australian government, the aims of the program included supporting development of effective, economically viable, and sustainable aged care nurse practitioner models of practice; and enabling improvements in access to primary health care for people aged older than 65 years.This article describes the process by which a framework was developed to support the evaluation of this program. A particular challenge for the nurse researchers involved in the evaluation was to ensure the unique values of the nursing profession were upheld alongside economic, biomedical, and empirical imperatives in the diverse processes involved in collecting and interpreting data. The evaluation framework developed provides an important means of enabling research teams who undertake complex evaluations of diverse nursing models of practice to maintain a common goal—to unify the various stakeholders involved, while at the same time upholding what is most important to the profession of nursing. This article highlights how nurses can play an influential role when involved in the multidisciplinary evaluation of new and innovative approaches to practice.
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47
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Fairbrother G, Chiarella M, Braithwaite J. Models of care choices in today’s nursing workplace: where does team nursing sit? AUST HEALTH REV 2015; 39:489-493. [DOI: 10.1071/ah14091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 03/23/2015] [Indexed: 11/23/2022]
Abstract
This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.
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48
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LETTERS TO THE EDITOR. Dimens Crit Care Nurs 2015; 34:57. [DOI: 10.1097/dcc.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The terms "model of health care," "service model." and "nursing model of practice" are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.
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Affiliation(s)
- Catherine Hungerford
- University of Canberra, Disciplines of Nursing and Midwifery, Faculty of Health , Canberra , Australia
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50
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King A, Long L, Lisy K. Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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