Clinicians' perceptions and recognition of practice improvement strategies to prevent harms to older people in acute care hospitals

Nurse competence provides more individuality in the care of older hospitalized people

AIM

The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient-centred care competence, and individuality in the care of older patients and to explore their associations.

DESIGN

A descriptive correlative survey.

METHODS

Data were collected using questionnaires at one Finnish university hospital during winter 2016-2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis.

RESULTS

Registered Nurses assessed their general competence, patient-centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient-centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.

Barriers and enablers to nurses' use of harm prevention strategies for older patients in hospital: A cross-sectional survey

BACKGROUND

Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse-led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood.

AIM

The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting.

DESIGN

Anonymous, online, cross-sectional survey.

METHODS

The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight-factor framework for comprehensive harm prevention. The STROBE reporting checklist was used.

RESULTS

Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9-10/10) (p = .024), and awareness of strategies for the eight-factor framework (p = .019) were significant enablers of comprehensive harm prevention.

CONCLUSION

Targeted evidence-based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward.

Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study

BACKGROUND

Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes.

AIM

Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital.

DESIGN

A multi-method qualitative study informed by frameworks of behaviour change and human-centred co-design.

METHODS

The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human-centred co-design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis.

RESULTS

Analysis revealed a 5-step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient.

CONCLUSION

The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.

Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study

AIMS

To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment.

DESIGN

Cross-sectional retrospective chart review.

METHODS

This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain.

RESULTS

A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems.

DISCUSSION

Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation.

IMPACT

Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.

Have you SCAND MMe Please? A framework to prevent harm during acute hospitalisation of older persons: A retrospective audit

AIMS AND OBJECTIVES

To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients.

BACKGROUND

It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients.

DESIGN

Retrospective audit of medical records.

METHODS

A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation.

RESULTS

Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation.

CONCLUSIONS

The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.