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Mahat S, Rafferty AM, Vehviläinen-Julkunen K, Härkänen M. Registered nurses' emotional responses to medication errors and perceived need for support: A qualitative descriptive analysis. J Adv Nurs 2024. [PMID: 38896107 DOI: 10.1111/jan.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/28/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
AIMS To identify the contributing factors behind the second victim phenomenon, describe the emotional responses of nurses after medication errors, assess the support received by them after errors and recognize the need for a suitable support program for second victims. DESIGN Qualitative descriptive design. METHODS Eleven in-depth semi-structured interviews were conducted among registered nurses studying advanced degrees at a University in Finland during November 2021-April 2022. Data were analysed using thematic analysis. RESULTS The study results revealed four themes with various sub-themes which included: contributing factors behind the second victim phenomenon; emotional responses of nurses after error; support received by nurses; and the desired need for a support program for second victims. The severity of the error and the negative work environment acted as catalysts for the second victim phenomenon among nurses. A "bitter aftermath" of emotions and a sense of insufficient support added further risk to already stressed and anxious nurses. CONCLUSIONS This study identifies the early exploratory and enduring impact of memories associated with medication errors, some of them haunting nurses for long periods of time. Further, the need for support at different levels is highlighted to reduce the impact of negative emotions generated among nurses after medication errors. IMPLICATIONS FOR THE PROFESSION Through the lens of this study, it has been possible to identify contributing factors behind the second-victim phenomenon and enduring symptoms that make nurses vulnerable to becoming second victims of medication incidents. IMPACT This study addresses the aftermath effect of medication errors from the perspective of nurses involved with such incidents. It provides valuable insights for healthcare managers and nurse leaders to establish a just and blame-free culture in healthcare organizations and help emotionally traumatized nurses cope effectively after error. REPORTING METHOD The research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sanu Mahat
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Research Centre for Nursing Science and Social and Health Management, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
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Morgan S. Nurse productivity: using evidence to enhance nurses' use of time. Nurs Stand 2024; 39:30-34. [PMID: 38343375 DOI: 10.7748/ns.2024.e12251] [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] [Accepted: 10/12/2023] [Indexed: 05/02/2024]
Abstract
The UK is experiencing a nursing shortage, making it challenging to maintain the staffing levels required to deliver effective patient care. One way of enhancing the care delivered by the existing workforce could be to optimise nurse productivity; however, previous efforts to do this have been largely ineffective, due in part to a focus on the processes of care delivery rather than the nursing activities within these processes. In this article, the author explores the concept of nurse productivity and suggests that enhancing productivity requires the identification of nursing activities and consideration of how these may be undertaken in a more time-efficient manner - or removed altogether. The author discusses two such activities: intentional (hourly) rounding, and fixed-time manual vital signs for patients on general wards. The author also considers the potential of using automatic continuous remote monitoring on general hospital wards to free up nurses' time for other care activities.
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Demir M, Håkansson E, Drott J. Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study. J Adv Nurs 2024; 80:2080-2090. [PMID: 37975326 DOI: 10.1111/jan.15966] [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: 06/25/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
AIM To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN A qualitative descriptive study design was used. METHODS A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Maria Demir
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Elin Håkansson
- Department of Surgery, Regional Hospital of Växjö, Växjö, Sweden
| | - Jenny Drott
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
- Division of Nursing Science and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Cooper AL, Albrecht MA, Kelly S, Eccles SP, Brown JA. A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives. J Adv Nurs 2024; 80:1452-1463. [PMID: 37983743 DOI: 10.1111/jan.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.
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Affiliation(s)
- Alannah L Cooper
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Matthew A Albrecht
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Kelly
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Siobhan P Eccles
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice, Curtin University, Perth, Western Australia, Australia
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Sommer D, Kasbauer J, Jakob D, Schmidt S, Wahl F. Potential of Assistive Robots in Clinical Nursing: An Observational Study of Nurses' Transportation Tasks in Rural Clinics of Bavaria, Germany. NURSING REPORTS 2024; 14:267-286. [PMID: 38391066 PMCID: PMC10885045 DOI: 10.3390/nursrep14010021] [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: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Transportation tasks in nursing are common, often overlooked, and directly impact patient care time in the context of staff shortages and an aging society. Current studies lack a specific focus on transportation tasks, a gap our research aims to fill. By providing detailed data on transportation needs in nursing, our study establishes a crucial foundation for the development and integration of assistive robots in clinical settings. In July and September 2023, we conducted weekly observations of nurses to assess clinical transportation needs. We aim to understand the economic impact and the methods nurses use for transportation tasks. We conducted a participant observation using a standardized app-based form over a seven-day observation period in two rural clinics. N = 1830 transports were made by nurses and examined by descriptive analysis. Non-medical supplies account for 27.05% (n = 495) of all transports, followed by medical supplies at 17.32% (n = 317), pharmacotherapy at 14.10% (n = 258) and other other categories like meals or drinks contributing 12.68% (n = 232). Most transports had a factual transport time of under a minute, with patient transport and lab samples displaying more variability. In total, 77.15% of all transports were made by hand. Requirements to collect items or connect transports with patient care were included in 5% of all transports. Our economic evaluation highlighted meals as the most costly transport, with 9596.16 € per year in the observed clinics. Budget-friendly robots would amortize these costs over one year by transporting meals. We support understanding nurses' transportation needs via further research on assistive robots to validate our findings and determine the feasibility of transport robots.
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Affiliation(s)
- Domenic Sommer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Jakob Kasbauer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Dietmar Jakob
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Sebastian Schmidt
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Florian Wahl
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
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Ivziku D, Gualandi R, Ferramosca FMP, Lommi M, Tolentino Diaz MY, Raffaele B, Montini G, Porcelli B, Stievano A, Rocco G, Notarnicola I, Latina R, De Benedictis A, Tartaglini D. Decoding Nursing Job Demands: A Multicenter Cross-Sectional Descriptive Study Assessing Nursing Workload in Hospital Medical-Surgical Wards. SAGE Open Nurs 2024; 10:23779608241258564. [PMID: 38836188 PMCID: PMC11149452 DOI: 10.1177/23779608241258564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 06/06/2024] Open
Abstract
Background Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload and work contexts. Purpose The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context. Methods We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts. Results We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency. Conclusions In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.
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Affiliation(s)
- Dhurata Ivziku
- Direction of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaella Gualandi
- Direction of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | | | | | | | | | | | - Alessandro Stievano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gennaro Rocco
- Department of Nursing, Catholic University "Our Lady of Good Counsel", Tirana, Albania
| | - Ippolito Notarnicola
- Department of Nursing, Catholic University "Our Lady of Good Counsel", Tirana, Albania
| | - Roberto Latina
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Anna De Benedictis
- Clinical Directory, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Daniela Tartaglini
- Direction of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Seman Z, Voo JYH, Mohamed Shah N. Nurses' perception of medication administration errors and factors associated with their reporting in the neonatal intensive care unit. Int J Qual Health Care 2023; 35:mzad101. [PMID: 38102640 DOI: 10.1093/intqhc/mzad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
Medication administration is a complex process, and nurses play a central role in this process. Errors during administration are associated with severe patient harm and significant economic burden. However, the prevalence of under-reporting makes it challenging when analysing the current landscape of medication administration error (MAE) and hinders the implementation of improvements to the existing system. The aim of this study is to describe the reasons for the occurrence of MAEs and the reasons behind the under-reporting of MAEs, to determine the estimated percentage of MAE reporting and to identify factors associated with them from the nurses' perspective. This cross-sectional study was conducted using a validated self-administered questionnaire. The questionnaire contained 65 questions which were divided into three sections: (i) reasons for the occurrence of MAEs, which consisted of 29 items; (ii) reasons for not reporting MAEs, which consisted of 16 items; and (iii) percentage of MAEs actually reported, which consisted of 20 items. It was distributed to 143 nurses in the neonatal intensive care units of five public hospitals in Malaysia. Multivariable logistic regression was used to identify the factors associated with MAE reporting. The estimated percentage of MAE reporting was 30.6%. The most common reasons for MAEs were inadequate nursing staff (5.14 [SD 1.25]), followed by drugs which look alike (4.65 [SD 1.06]) and similar drug packaging (4.41 [SD 1.18]). The most common reasons for not reporting MAEs were that nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.56 [SD 1.32]) and that too much emphasis is placed on MAEs as a measure of the quality of nursing care (4.31 [SD 1.23]). Factors statistically significant with MAE reporting were administration response (adjusted odds ratio [AOR] = 6.90; 95% confidence interval (CI) = 2.01-23.67; P = 0.002), reporting effort (AOR = 3.67; 95% CI = 1.68-8.01; P = 0.001), and nurses with advanced diploma (AOR = 0.29; 95% CI = 0.13-0.65; P = 0.003). Our findings show that under-reporting of MAEs is still common and less than a third of the respondents reported MAEs. Therefore, to encourage error reporting, emphasis should be placed on the benefits of reporting, adopting a non-punitive approach, and creating a blame-free culture.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Persiaran Murni, Setia Alam, Shah Alam, Selangor 40170, Malaysia
| | - James Yau Hon Voo
- Department of Pharmacy, Hospital Duchess of Kent, Ministry of Health Malaysia, KM 3.2, Jalan Utara, Sandakan, Sabah 90000, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
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Pantha S, Jones M, Gray R. Stakeholders' Perceptions of How Nurse-Doctor Communication Impacts Patient Care: A Concept Mapping Study. NURSING REPORTS 2023; 13:1607-1623. [PMID: 37987412 PMCID: PMC10661264 DOI: 10.3390/nursrep13040133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
There is some evidence that aspects of nurse-doctor communication are associated with the quality of care and treatment patients receive whilst they are in hospital. To date, no studies have examined stakeholder perceptions on how patient care is influenced by clinical communication between nurses and doctors. We conducted a concept mapping study to generate a deep understanding of how clinical communication impacts patient care. Concept mapping has six phases: preparation, idea generation, structuring, representation, interpretation, and utilization. A total of 20 patients, 21 nurses, and 21 doctors participated in the study. Brainstorming generated 69 discreet statements about how nurse-doctor communication impacts patient care. The structuring (rating and clustering) phase was completed by 48 participants. The data interpretation workshop selected a five-cluster solution: effective communication, trust, patient safety, impediments to patient care, and interpersonal skills. On the final concept map, the five clusters were arranged in a circle around the center of the map. Clusters were relatively equal in size, suggesting that each concept makes a broadly equal contribution to how nurse-doctor communication influences patient care. Our study suggests that there are multiple aspects of clinical communication that impact patient care. Candidate interventions to enhance nurse-doctor communication may need to consider the complex nature of interprofessional working. Registration: This study was prospectively registered with the Open Science Framework (OSF) on 09.07.2020 (osf.io/9np8v/) prior to recruiting the first participant.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Noorie, SA 5608, Australia;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
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Kramer S, Raymond MJ, Hunter P, Saultry B, Gibbs H, Dignam F, Lannin NA, Bucknall T. Understanding the workflow of nurses in acute and subacute medical wards: A time and motion study. J Clin Nurs 2023; 32:7773-7782. [PMID: 37489643 DOI: 10.1111/jocn.16835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings. BACKGROUND Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources. DESIGN Time and motion cross-sectional observational study and reported the study according to the STROBE guideline. METHODS Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real-time task-related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre-determined tasks were recorded and included direct care, indirect care, documentation, medication-related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded. RESULTS Twenty-one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May-July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication-related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking. CONCLUSIONS Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication-related tasks. Local-level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well-established and should be an ongoing area of attention including observations and education provided in local settings.
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Affiliation(s)
- Sharon Kramer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
| | | | | | | | - Harry Gibbs
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Al-Moteri M, Alzahrani AA, Althobiti ES, Plummer V, Sahrah AZ, Alkhaldi MJ, Rajab EF, Alsalmi AR, Abdullah ME, Abduelazeez AEA, Caslangen MZM, Ismail MG, Alqurashi TA. The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis. Healthcare (Basel) 2023; 11:2216. [PMID: 37570456 PMCID: PMC10418769 DOI: 10.3390/healthcare11152216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amer A. Alzahrani
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Ensherah Saeed Althobiti
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Berwick, VIC 3806, Australia;
| | - Afnan Z. Sahrah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Maha Jabar Alkhaldi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Eishah Fahad Rajab
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Amani R. Alsalmi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Merhamah E. Abdullah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | | | - Mari-zel M. Caslangen
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Mariam G. Ismail
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Talal Awadh Alqurashi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
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11
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Ausserhofer D, Tappeiner W, Wieser H, Serdaly C, Simon M, Zúñiga F, Favez L. Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study. BMC Geriatr 2023; 23:347. [PMID: 37268879 DOI: 10.1186/s12877-023-04022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/06/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes. PURPOSE The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession). METHODS This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. RESULTS Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession. CONCLUSION This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession.
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Affiliation(s)
- Dietmar Ausserhofer
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Waltraud Tappeiner
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
| | - Heike Wieser
- Claudiana Research, College of Health Care-Professions, Bolzano-Bozen, Italy
| | - Christine Serdaly
- Serdaly&Ankers Snc, 210 Route de Florissant, 1231, Conches, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Lauriane Favez
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland.
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, Yverdon-les-Bains, Switzerland.
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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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13
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Saralegui-Gainza A, Soto-Ruiz N, Escalada-Hernández P, García-Vivar C, Rivera D, Martín-Rodríguez LS. Assessing the Reliability and Validity of the Spanish Version of the Actual Scope of Nursing Practice Scale. Healthcare (Basel) 2023; 11:healthcare11081170. [PMID: 37108005 PMCID: PMC10138610 DOI: 10.3390/healthcare11081170] [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: 03/19/2023] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Nursing workforce shortage is one of the main challenges for healthcare organizations and it is important to determine if nurses are fulfilling their full scope of practice. There is a questionnaire that measures the activities carried out by nurses, but there is no version available for the Spanish context. The purpose of this study was to develop a cross-cultural adaptation of the "Actual Scope of Nursing Practice" questionnaire by D'Amour et al., and to assess the psychometric characteristics of the Spanish version. An exploratory sequential research design was used. The cross-cultural adaptation was performed using translation, back-translation, review, and pre-testing. Psychometric properties were assessed to determine its construct validity and internal consistency. Among the 501 eligible nurses from the three main hospitals in the region, the first 310 nurses to respond to an online questionnaire were included in our study. The response rate was 61.9%. They were invited via email and completed the survey using the SurveyMonkey platform. The Spanish version of the questionnaire was obtained. A final scale with twenty items and two factors was confirmed with an adequate fit, with the item scores demonstrating that all items were optimally related to their respective latent construct. The alpha coefficients for the Spanish ASCOP scale were robust and revealed good internal consistency. This study showed that the Spanish version of the scale, "Scope of Nursing Practice", has a good degree of validity and reliability. This questionnaire can support nurse managers in realising nursing activities within their organisations and in promoting desirable work outcomes among nurses.
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Affiliation(s)
- Amaia Saralegui-Gainza
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Diego Rivera
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
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Mak S, Hunt M, Riccio SS, Razack S, Root K, Thomas A. Attrition and Retention of Rehabilitation Professionals: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; Publish Ahead of Print:00005141-990000000-00060. [PMID: 36881451 DOI: 10.1097/ceh.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals. METHODS We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology. RESULTS Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition. DISCUSSION Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push , pull , and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.
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Affiliation(s)
- Susanne Mak
- Ms. Mak: Assistant Professor (professional), School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada. Dr. Hunt: Associate Professor, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada. Ms. Riccio: Physical Therapist, PhysioMobile Inc., Montréal, Québec, Canada. Dr. Razack: Professor, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada and Department of Pediatrics, McGill University, Montréal, Québec, Canada. Ms. Root: Assistant Professor (professional), School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada. Dr. Thomas: Associate Professor, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada
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Arcara J, Cuentos A, Abdallah O, Armstead M, Jackson A, Marshall C, Gomez AM. What, when, and how long? Doula time use in a community doula program in San Francisco, California. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231155302. [PMID: 36869648 PMCID: PMC9989372 DOI: 10.1177/17455057231155302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Community doulas, who provide culturally concordant, nonclinical support during and after pregnancy, are increasingly promoted as an evidence-based intervention to advance birth equity. As valued members of their communities, community doulas often provide extensive physical and emotional pregnancy, birth, and postpartum support at low or no cost to clients. However, neither community doulas' scope of work nor the distribution of time among their different work activities has been clearly defined or enumerated; therefore, this project sought to describe the work activities and time use of doulas in one community-based doula organization. METHODS In a quality improvement project, we reviewed case management system client data and collected 1 month of time diary data from eight doulas employed full-time at SisterWeb San Francisco Community Doula Network. We calculated descriptive statistics for activities community doulas reported in their time diaries and each visit/interaction logged in the case management system. RESULTS SisterWeb doulas spent about half of their time in direct client care. For every hour that doulas spent with a client in prenatal and postpartum visits, on average, they spent an additional 2.15 h communicating with and supporting their clients in other ways. Overall, we estimate that SisterWeb doulas spend an average of 32 h providing care for a client receiving the standard course of care, including intake, prenatal visits, support during childbirth, and postpartum visits. CONCLUSIONS Results highlight the wide variety of work that SisterWeb community doulas do beyond direct client care. Acknowledgment of community doulas' broad scope of work and appropriate compensation for all activities is necessary if doula care is to be advanced as a health equity intervention.
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Affiliation(s)
- Jennet Arcara
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, CA, USA
| | - Alli Cuentos
- SisterWeb San Francisco Community Doula Network, San Francisco, CA, USA
| | - Obaida Abdallah
- SisterWeb San Francisco Community Doula Network, San Francisco, CA, USA.,School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Marna Armstead
- SisterWeb San Francisco Community Doula Network, San Francisco, CA, USA
| | - Andrea Jackson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, CA, USA
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Knox MK, Mehta PD, Dorsey LE, Yang C, Petersen LA. A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload. Appl Clin Inform 2023; 14:76-90. [PMID: 36473498 PMCID: PMC9891851 DOI: 10.1055/a-1993-7627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. METHODS Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. RESULTS As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. CONCLUSION Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.
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Affiliation(s)
- Melissa K. Knox
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Paras D. Mehta
- Department of Medicine, University of Houston, Houston, Texas, United States
| | | | - Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
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17
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Karvonen S, Holma T, Korpelainen J, Leivonen K, Michelsson K, Rantala MR, Porkkala T, Lukkarila P. Key Flow Processes on Wards. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:208-222. [PMID: 36325801 DOI: 10.1177/19375867221134550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The aim of the study is to test a new nurse movement route analysis (NMRA) method for measuring nurses’ traffic volume between rooms on wards. Background: The World Health Organization calls for urgent investment in nurses. On the other hand, the challenges in the availability, direct care activity, and staffing of registered nurses make increasing the quality of care by process improvement a central objective for nursing. Method: The method is based on cellular operations with from/to matrix that describes nurse movements between rooms on a ward. The NMRA can be implemented by traditional manual observation or with a novel internet-of-things solution named SKAnalysis. Results: The greatest nurse flows led to patient rooms, nurses’ stations, and medicine rooms. The manual NMRA recorded a total of 3,040 room visits by nurses; visits to patient rooms accounted for 33% of all room visits, while visits to nurses’ stations accounted for 28%, and visits to the medicine room for 10%. The internet-of-things NMRA recorded a total of 25,841 room visits by nurses; patient room visits accounted for about 43% of all room visits, while nurses’ station visits accounted for 26% and medicine room visits for about 8%. Based on the results, researchers present the development examples and priorities for nursing. Conclusions: NMRA works and is a new universal method for analyzing nurses’ traffic which is a basic premise for improving working methods and productivity on the wards. Internet-of-things solution makes the implementation of NMRA six times more efficient than by the manual NMRA.
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Affiliation(s)
| | - Tuomas Holma
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Juha Korpelainen
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Kirsi Leivonen
- Siun sote – Joint municipal authority for North Karelia social and health services, Finland
| | | | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
| | - Pirjo Lukkarila
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
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Ivziku D, de Maria M, Ferramosca FMP, Greco A, Tartaglini D, Gualandi R. What determines physical, mental and emotional workloads on nurses? A cross-sectional study. J Nurs Manag 2022; 30:4387-4397. [PMID: 36205923 DOI: 10.1111/jonm.13862] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aimed to identify determinants of physical, mental and emotional nursing workloads. BACKGROUND Workload has a physical, mental and emotional dimension. It influences employees' well-being and quality of care. Nevertheless, studies of specific predictors for each dimension of nurses' workload are scarce. METHODS We used a cross-sectional prospective design based on the Job Demand-Resources theory. We asked nurses to describe workload perceived at the end of every shift over three consecutive weeks. Data were gathered from two academic hospitals, in seven medical-surgical wards. We received 259 responses and tested 2 multivariate regression models. RESULTS Physical workload was predicted from all variables tested; mental workload was determined by patient complexity or isolation, adequacy of nurse staffing and skill-mix, and unscheduled activities; and emotional workload was predicted by all variables except adequacy of staffing and other people's education. CONCLUSIONS Patient, nurse and workflow aspects influenced nurse's shift workload differently for each specific dimension. IMPLICATIONS FOR NURSING MANAGEMENT Measurement and definition of predictors of workload in the work environment are essential. Recognizing the determinants of specific dimensions of workload facilitates identification of the most appropriate interventions to improve nurses' well-being in health care settings.
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Affiliation(s)
- Dhurata Ivziku
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Maddalena de Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Andrea Greco
- Gynecologic and Midwifery Unit, Ospedale Vito Fazzi, ASL Lecce, Lecce, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Raffaella Gualandi
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
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Khan AR, Rosenthal CD, Ternes K, Sing RF, Sachdev G. Time Spent by Intensive Care Unit Nurses on the Electronic Health Record. Crit Care Nurse 2022; 42:44-50. [PMID: 36180057 DOI: 10.4037/ccn2022518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record. OBJECTIVE To quantify the amount of time spent by intensive care unit nurses on the electronic health record. METHODS In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated. RESULTS Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month. CONCLUSION Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.
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Affiliation(s)
- Ahsan R Khan
- Ahsan R. Khan is a medical student at the Morehouse School of Medicine in Atlanta, Georgia
| | - Courtney D Rosenthal
- Courtney D. Rosenthal is a registered surgical-trauma intensive care unit nurse and nurse educator, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Kelly Ternes
- Kelly Ternes is a registered surgical-trauma intensive care unit nurse, Carolinas Medical Center, Atrium Health
| | - Ronald F Sing
- Ronald F. Sing is an acute care surgeon, Carolinas Medical Center, Atrium Health
| | - Gaurav Sachdev
- Gaurav Sachdev is an acute care surgeon, Carolinas Medical Center, Atrium Health
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Krohne J. Reframing nurses' time to enhance interpersonal interactions in dementia care. Nurs Older People 2022; 34:e1402. [PMID: 35946385 DOI: 10.7748/nop.2022.e1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.
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Affiliation(s)
- John Krohne
- School of Sport and Health Sciences, University of Brighton, Brighton, England
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Abt M, Lequin P, Bobo ML, Vispo Cid Perrottet T, Pasquier J, Ortoleva Bucher C. The scope of nursing practice in a psychiatric unit: A time and motion study. J Psychiatr Ment Health Nurs 2022; 29:297-306. [PMID: 34310817 PMCID: PMC9290684 DOI: 10.1111/jpm.12790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: The evaluation of nurse care practices poses many challenges, including the identification of all the aspects of the care given. Few studies have looked at the scope of nursing practice in psychiatry. However, the evaluation of care practices in the mental health field poses many challenges, including the identification of all aspects of care. WHAT THE DOCUMENT ADDS TO EXISTING KNOWLEDGE?: Findings demonstrated that mental health nurses do not invest in all domains of their scope of practice in the same way and the time spent with patients is low. Several factors contributed to this, including the increasing complexity of care, stagnant staffing levels, and a culture of care that continues to be influenced by the medical model. Current models of care still retain the stigma of this past, prioritizing medically delegated tasks rather than promoting a holistic approach to care. Although the professional identity of nurses is evolving and asserting itself, the paradigm shift in practice is still incomplete. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to describe concretely what is actually expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement. The field of practice of nurses is put under stress by a demanding work environment subject to many pressures and constraints. Changing practices so that nurses can use the full scope of nursing practice requires strong nursing leadership and action on education and the organization of care, particularly on clinical assessment. ABSTRACT: Introduction The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry. Aim The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017, Perspect Infirm Rev Off Ordre Infirm Qué, 14, 51) Scope of Nursing Practice Model. Method This 56-day descriptive observational study used the time and motion method to follow eight nurses. Results 500 h of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education. Discussion Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.
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Affiliation(s)
- Maryline Abt
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Pierre Lequin
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Louise Bobo
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
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22
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Slyngstad L, Helgheim BI. How Do Different Health Record Systems Affect Home Health Care? A Cross-Sectional Study of Electronic- versus Manual Documentation System. Int J Gen Med 2022; 15:1945-1956. [PMID: 35237067 PMCID: PMC8882660 DOI: 10.2147/ijgm.s346366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate electronic health record (EHR) systems compared to manual systems (MS) in home health care and how documentation and reporting activities are impacted regarding time use, variation, and accuracy. Methods This is a cross-sectional study of two municipalities (M1 and M2) that use statistical process control charts and interview with caregivers to discuss the issue. Regarding reporting, 309 observations were used for the control charts in M1 and 572 for those in M2. Concerning documentation, 831 observations were used for M1 and 572 for M2. In addition, interviews were conducted with four caregivers from each municipality. Results The municipality with EHR system use 3% of their total time for documentation and 7% for reporting. The municipality with the MS uses 7% of their total time in documentation and 12% for reporting. There is less variation in the charts for the municipality with the EHR system, than for the municipality using an MS. Conclusion The municipality using the EHR system uses less time for documentation and reporting than the other municipality. This is probably due to the standardization of information in M1, and that M2 needs to record documentation twice. The standardization arising from EHR use system may cause less variation in the process than the MS, but less variation might also negatively affect information accuracy. Reduced time for oral reporting also affects information accuracy.
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Affiliation(s)
- Line Slyngstad
- Department of Logistics, Molde University College, Molde, 6410, Norway
- Correspondence: Line Slyngstad, Department of Logistics, Molde University College, Molde, 6410, Norway, Tel +4741621248, Email
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Levin C, Zisberg A, Gil E, Rand D, Agmon M. ‘Behind the scenes’ of accelerometer use to quantify in-hospital mobility of older adults. Arch Phys Med Rehabil 2022; 103:1676-1683.e1. [DOI: 10.1016/j.apmr.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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