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Reichert D, Gummesson K, Wallin L, Dahlström T. Implementing care-related services in care units - an interview study. BMC Health Serv Res 2024; 24:976. [PMID: 39180075 PMCID: PMC11344403 DOI: 10.1186/s12913-024-11465-3] [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: 04/15/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The growing concern about a dwindling healthcare workforce, exacerbated by demographic changes, calls for innovative solutions. One viable approach involves implementing new professional roles and restructuring existing healthcare teams within hospital care units. OBJECTIVES To evaluate the implementation of an innovative task-shifting concept, care-related services (CRS), from the managers' perspective in somatic care units across the hospitals in a region in Sweden. METHODS The qualitative study was conducted in 2022, after the implementation of CRS. Individual interviews were conducted with 24 key stakeholders, including 14 care unit managers, six CRS managers, and four process managers. A qualitative content analysis was performed, utilizing the Consolidated Framework of Implementation Research (CFIR). RESULTS The implementation of CRS involved collaboration between care unit managers, CRS managers, and project managers, alongside CRS staff, registered nurses (RNs), and licensed vocational nurses (LVNs). In particular, their roles encompassed defining boundaries, establishing routines, and managing personnel. Throughout the implementation process, challenges emerged, stemming from undefined goals, difficulties in recruiting qualified CRS staff, and issues associated with seamlessly integrating CRS into existing work routines. These challenges arose due to a constrained timeframe, widespread team apprehension, shortcomings in the training of CRS staff, unclear task allocation, and an increased workload for care unit managers. Factors associated with successful CRS implementation included effective cooperation among managers and an open-minded approach. CONCLUSIONS Our findings highlight the crucial role of clear communication, effective recruitment, integration of CRS staff, clarification of roles, responsibilities, and defined goals for successful CRS implementation.
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Affiliation(s)
- Dorothea Reichert
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
- Dalarna County Council, Falun, Sweden.
| | - Karl Gummesson
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Dalarna County Council, Falun, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Tobias Dahlström
- Dalarna County Council, Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Hayward BA. A job analysis of mental health nursing in a school for students with intellectual and developmental disabilities. Int J Ment Health Nurs 2024; 33:957-966. [PMID: 38291653 DOI: 10.1111/inm.13297] [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: 10/07/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self-reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant-participator in a single-case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health.
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Affiliation(s)
- Brent A Hayward
- Department of Education, East Melbourne, Victoria, Australia
- Department of Education, School of Social and Political Sciences, Faculty of Arts, University of Melbourne, Parkville, Victoria, Australia
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Turcato G, Zaboli A, Brigo F, Parodi M, Fulghesu F, Bertorelle L, Sibilio S, Mian M, Ferretto P, Milazzo D, Trentin M, Marchetti M. Is the National Early Warning Score able to identify nursing activity load? A prospective observational study. Int J Nurs Stud 2024; 154:104749. [PMID: 38522185 DOI: 10.1016/j.ijnurstu.2024.104749] [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: 10/07/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The National Early Warning Score scale correlates well with the intensity of the patient's acute condition. It could also correlate with the nursing activity load and prove useful in defining and redistributing nursing resources based on the acuity of patients. AIM To assess whether patients' National Early Warning Score at hospital admission correlates with objective nursing demands and can be used to optimize the distribution of available care resources. METHODS This single-center prospective study included patients admitted to the Department of Internal Medicine at the Civil Hospital in Altovicentino (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first three days after admission and standardized to the daily mean as performance/5 min/patient/day. Linear regression was used to assess the correlation between nursing demands for different National Early Warning Scores. RESULTS This study included 333 patients. Their mean National Early Warning Score was 3.9 (standard deviation: 2.9), with 61 % (203/333) in the National Early Warning Score <5 category, 19.5 % (65/333) in the National Early Warning Score 5-6 category, and 19.5 % (65/333) in the National Early Warning Score >6 category. Their average daily care requirements increased from 22 (16-30) activities/5 min/patient/day in the low National Early Warning Score category to 30 (20-39) activities/5 min/patient/day in the intermediate National Early Warning Score category (p < 0.001) and 35 (23-45) activities/5 min/patient/day in the high National Early Warning Score category (p < 0.001). CONCLUSION The National Early Warning Score correlates with nursing care activities for patients with an acute condition and can be used to optimize the distribution of available care resources.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Francesca Fulghesu
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Lidia Bertorelle
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Serena Sibilio
- Universitat Basel Department Public Health, Institute of Nursing Science, Basel, BS, Switzerland
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy; College of Health Care-Professions Claudiana, Bozen, Italy
| | - Paolo Ferretto
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Daniela Milazzo
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Monica Trentin
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
| | - Massimo Marchetti
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy
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Beaulieu M, Roy J, Chênevert D, Rebolledo C, Landry S. Lessons learned from the pandemic: expanding the collaboration between clinical and logistics activities in a hospital. J Health Organ Manag 2024; ahead-of-print. [PMID: 38526451 DOI: 10.1108/jhom-12-2022-0363] [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: 03/26/2024]
Abstract
PURPOSE The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution? DESIGN/METHODOLOGY/APPROACH The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment. FINDINGS The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made. ORIGINALITY/VALUE The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.
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Affiliation(s)
- Martin Beaulieu
- Department of Logistics and Operations Management, HEC Montreal, Quebec, Canada
| | - Jacques Roy
- Department of Logistics and Operations Management, HEC Montreal, Quebec, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montreal, Quebec, Canada
| | - Claudia Rebolledo
- Department of Logistics and Operations Management, HEC Montreal, Quebec, Canada
| | - Sylvain Landry
- Department of Logistics and Operations Management, HEC Montreal, Quebec, Canada
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Salgado R, Paulo N, Zufferey A, Bucher CO. Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study. J Clin Nurs 2023; 32:6415-6426. [PMID: 36823713 DOI: 10.1111/jocn.16656] [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: 06/29/2022] [Revised: 10/27/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIMS AND OBJECTIVES Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital. BACKGROUND After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE). METHODS Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study. RESULTS Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level. CONCLUSIONS This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing. RELEVANCE TO CLINICAL PRACTICE Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process. NO PATIENT OR PUBLIC CONTRIBUTION For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.
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Affiliation(s)
- Ricardo Salgado
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health Care (IUFRS), Lausanne, Switzerland
| | - Natércia Paulo
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health Care (IUFRS), Lausanne, Switzerland
| | - Arnaud Zufferey
- Cardiology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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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: 2] [Impact Index Per Article: 2.0] [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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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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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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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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11
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Abt M, Lequin P, Bobo M, 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] [MESH Headings] [Grants] [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 SciencesHES‐SO University of Applied Sciences and Arts WesternLausanneSwitzerland
| | - Pierre Lequin
- Department of PsychiatryLausanne University HospitalLausanneSwitzerland
| | - Marie‐Louise Bobo
- Institute of Higher Education and Research in HealthcareUniversity of LausanneLausanneSwitzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing SciencesHES‐SO University of Applied Sciences and Arts WesternLausanneSwitzerland
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12
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Gee JP, Palmer M, Friel BA, Collingridge DS. Challenging tradition: Nurses' attitudes toward single checking of subcutaneous insulin. Nursing 2022; 52:52-57. [PMID: 34979015 DOI: 10.1097/01.nurse.0000803528.94354.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Peila Gee
- Julie Peila Gee is a clinical associate professor at the University of Utah's College of Nursing. At Intermountain Healthcare, Maryanne Palmer is a continuous improvement consultant, Beth Ann Friel is a professional practice consultant, and Dave S. Collingridge is a senior research statistician
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13
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Härkänen M, Vehviläinen-Julkunen K, Franklin BD, Murrells T, Rafferty AM. Factors Related to Medication Administration Incidents in England and Wales Between 2007 and 2016: A Retrospective Trend Analysis. J Patient Saf 2021; 17:e850-e857. [PMID: 32168268 DOI: 10.1097/pts.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to describe medication administration incidents reported in England and Wales between 2007 and 2016, to identify which factors (reporting year, type of incident, patients' age) are most strongly related to reported severity of medication administration incidents, and to assess the extent to which relevant information was underreported or indeterminate. METHODS Medication administration incidents reported to the National Reporting & Learning System between January 1, 2007, and December 31, 2016 were obtained. Characteristics of the data were described using frequencies, and relationships between variables were explored using cross-tabulation. RESULTS A total of 517,384 incident reports were analyzed. Of these, 97.1% (n = 502,379) occurred in acute/general hospitals, mostly on wards (69.1%, n = 357,463), with medicine the most common specialty area (44.5%, n = 230,205). Medication errors were most commonly omitted doses (25.8%, n = 133,397). The majority did not cause patient harm (83.5%, n = 432,097). When only incidents causing severe harm or death (n = 1,116) were analyzed, the most common type of error was omitted doses (24.1%). Most incidents causing severe harm or death occurred in patients aged 56 years or older. For the 10-year period, the percentage of incidents with "no harm" increased (74.1% in 2007 to 86.3% in 2016). For some variables, data were often missing or indeterminate, which has implications for data analysis. CONCLUSIONS Medication administration incidents that do not cause harm are increasingly reported, whereas incidents reported as severe harm and death have declined. Data quality needs to be improved. Underreporting and indeterminate data, inaccuracies in reporting, and coding jeopardize the overall usefulness of these data.
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Affiliation(s)
- Marja Härkänen
- From the Department of Nursing Science, University of Eastern Finland
| | | | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Charing Cross Hospital, Imperial College Healthcare NHS Trust and UCL School of Pharmacy
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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14
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Identifying Risk Areas of Medication Administration Process for Developing an Interactive Three-Dimensional Game Intervention. Comput Inform Nurs 2021; 38:524-533. [PMID: 32732642 DOI: 10.1097/cin.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to describe identified risk areas related to the medication administration process in acute care in order to develop a three-dimensional-game intervention. A secondary analysis was conducted using (1) observed medication administrations (n = 1058) and identified medication errors in 2012 (n = 235), (2) a systematic review including a meta-analysis of previous medication administration educational interventions (n = 14) from 2000 to 2015, (3) incident reports of medication administration errors (n = 1012) from 2013 to 2014, and (4) focus group interviews with RNs' (n = 20) views in 2015. A qualitative content analysis was used to identify risk areas, and the data were organized according to the following main themes: (1) factors related to patients (patient identification, patients' characteristics or symptoms, and patients' allergies and interactions); (2) factors related to medications (medication information, changes in medications, generic substitutes, new drugs, look-alike/sound-alike drugs, demanding drug treatments, medication preparation, and administration techniques); (3) factors related to staffing (workload, skills, interruptions and distractions, division of work, responsibility, attitudes, and guidelines); and (4) factors related to communication (flow of information, communication with the patients, and marking of medication information). Identified risk areas could be used to develop interventions with the aim of increasing the safety of medication administration and nurses' skills.
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15
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Michel O, Garcia Manjon AJ, Pasquier J, Ortoleva Bucher C. How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit. J Adv Nurs 2021; 77:4459-4470. [PMID: 34133039 PMCID: PMC8518809 DOI: 10.1111/jan.14935] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. Design A single‐centre observational descriptive study. Method Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions. Results A total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time. Conclusion This study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice. Impact Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.
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Affiliation(s)
- Olivia Michel
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Health Sciences (HEdS-FR), University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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16
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Peterson H, Uibu E, Kangasniemi M. Care left undone and work organisation: A cross-sectional questionnaire-based study in surgical wards of Estonian hospitals. Scand J Caring Sci 2021; 36:285-294. [PMID: 33894008 DOI: 10.1111/scs.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing. OBJECTIVE To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia. METHODS A cross-sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher's exact test. The open-ended questions were analysed with deductive content analysis. RESULTS Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone. CONCLUSIONS Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone.
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Affiliation(s)
| | - Ere Uibu
- Department of Nursing Science, Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.,Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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Müller R, Cohen C, Delmas P, Pasquier J, Baillif M, Ortoleva Bucher C. Scope of nursing practice on a surgery ward: A time-motion study. J Nurs Manag 2021; 29:1785-1800. [PMID: 33772929 DOI: 10.1111/jonm.13318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
AIM To log the activities of registered nurses and nursing assistants on a visceral surgery ward. BACKGROUND By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for health care systems to function effectively and efficiently. METHOD A descriptive observational time-motion study was conducted over a period of 48 days. The activities of nurses (n = 24) and nursing assistants (n = 9) were logged over the course of their entire work shifts, both in the day and at night. RESULTS In all, 499 hr of observation were logged. Tasks that fell under the dimensions of care activities and of communication and care coordination, which cover documentation, non-care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under-engaged in. CONCLUSION The study shows that the scope of nursing practice was not optimal. IMPLICATION FOR NURSING MANAGEMENT The results can serve to improve the work environment of carers, optimize the use of human resources and increase the visibility and efficiency of nursing work.
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Affiliation(s)
- Roxanne Müller
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health, Lausanne, Switzerland
| | - Christine Cohen
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Philippe Delmas
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marine Baillif
- Visceral Surgery Ward, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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18
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Cooper AL, Brown JA, Eccles SP, Cooper N, Albrecht MA. Is nursing and midwifery clinical documentation a burden? An empirical study of perception versus reality. J Clin Nurs 2021; 30:1645-1652. [PMID: 33590554 DOI: 10.1111/jocn.15718] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/14/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To measure time spent on clinical documentation and nurses and midwives' perceptions of this aspect of their role. BACKGROUND Nurses and midwives rely on accurate documentation when planning care. However, documenting and communicating care can be onerous, time-consuming and at times duplicated or redundant. While documentation provides a record and means of communicating care, it should not detract from the delivery of care. DESIGN An observational time and motion study and survey design reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS The study was conducted with Western Australian nurses and midwives working in a private not-for-profit hospital from July-October 2019. An observational study was undertaken to measure the practice of documentation on each shift. Participants' perceptions of clinical documentation were measured using a self-report survey. RESULTS A total of 120 hr of observation were undertaken. Total observed time spent on documentation was 28.1% on morning shifts, 22.7% on afternoon shifts and 20.9% on night duty. The mean self-reported time for clinical documentation was 50.4% on morning shifts, 40.7% on afternoon shifts and 37.9% on night duty. Issues with duplication and unnecessary paperwork were identified. CONCLUSIONS Although participants tended to overestimate time spent on documentation, it still consumed a significant proportion of time. Frustrations with paperwork may amplify nurses' negative perceptions of documentation. Clinical documentation needs to be reviewed, revised and reduced to release time back to direct patient care and reduce clinician dissatisfaction. RELEVANCE TO CLINICAL PRACTICE Clinical documentation is required in all areas of clinical practice and forms an important legal record. Understanding the demands of clinical documentation can assist in reviewing and improving documentation to release time back to direct patient care.
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Affiliation(s)
| | - Janie A Brown
- School of Nursing Midwifery & Paramedicine, Curtin University, Bentley, WA, Australia
| | | | | | - Matthew A Albrecht
- St John of God Subiaco Hospital, Subiaco, WA, Australia.,School of Public Health, Curtin University, Bentley, WA, Australia
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19
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Davies C, Lyons C, Whyte R. Optimizing nursing time in a day care unit: Quality improvement using Lean Six Sigma methodology. Int J Qual Health Care 2020; 31:22-28. [PMID: 31665293 DOI: 10.1093/intqhc/mzz087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/20/2019] [Accepted: 09/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study applies Lean Six Sigma (LSS) to improve the efficiency of a private hospital day care unit and generate a positive impact on optimizing nursing time and improving personalized patient care and staff satisfaction. DESIGN A prospective interventional study using pre- and post-evaluation. SETTING A day care unit at a private hospital. PARTICIPANTS Nurses and patients from the day unit. INTERVENTION(S) Define, Measure, Analyze, Improve and Control was used as an overarching problem-solving framework. All front line staff, clinical leaders and managers were supported as active change agents in the quality improvement (QI) initiative. Multiple interventions were adopted across the service that aimed to de-implement non-value added activities and enhance processes with activities that added value. MAIN OUTCOME MEASURES Patient turnaround times (PTTs), nursing time, nurse-patient ratio, nurse and patient survey. RESULTS A post-implementation evaluation highlighted significant improvements in service performance and patient and staff satisfaction. Significant added value includes a reduction in PTTs, an increase in nursing care time and improvement in the nurse-patient ratio. CONCLUSION This project identified that utilizing LSS that relies on collaborative team effort is effective in creating a positive organizational culture for improvement and change. The Six Sigma tools and techniques provide evidence-based approaches that support QI in practice.
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Affiliation(s)
- Carmel Davies
- School of Nursing,Midwifery and Health Systems,University College Dublin, Belfield, Dublin 4, Ireland. D04 V1W8
| | - Caroline Lyons
- Bon Secours Health System,Renmore,Co. Galway, Ireland. H91 KC7H
| | - Regina Whyte
- Bon Secours Health System,Renmore,Co. Galway, Ireland. H91 KC7H
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20
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Brown JA, Cooper AL, Albrecht MA. Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. J Adv Nurs 2020; 76:1273-1281. [PMID: 32027387 DOI: 10.1111/jan.14320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 11/29/2022]
Abstract
AIM To develop a validated tool to measure nursing and midwifery documentation burden. BACKGROUND While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. DESIGN Survey development, followed by rwo rounds of content validation (April and May 2019). METHODS Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. RESULTS Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. CONCLUSION The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. IMPACT The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received.
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Affiliation(s)
- Janie A Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Alannah L Cooper
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.,St John of God Subiaco Hospital, Subiao, Australia
| | - Matthew A Albrecht
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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21
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Therapy Workloads in Pediatric Health: Preliminary Findings and Relevance for Defining Practice. Pediatr Phys Ther 2020; 32:52-59. [PMID: 31842097 DOI: 10.1097/pep.0000000000000665] [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: 11/26/2022]
Abstract
PURPOSE To measure time spent by pediatric physical and occupational therapists in performing daily work activities. METHODS Physical and occupational therapists at an urban pediatric academic hospital were observed during a standard workday. Time studies recorded total time spent performing patient care and other workplace-specific tasks. Data were analyzed to identify trends. RESULTS Broad similarities existed in average amounts of time spent in direct patient care, indirect patient care, and nonpatient care tasks. Indirect patient care tasks demonstrated the lowest variability in time spent. CONCLUSIONS This is the first report of pediatric physical and occupational therapists' time in performing daily tasks. The metric and tools derived from these findings support managerial decision-making, provide a comparison of actual versus targeted workload, assist with determining appropriate and safe staffing caseloads, and contribute to measurements of a patient's therapy acuity level.Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A280.
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Glantz A, Örmon K, Sandström B. "How do we use the time?" - an observational study measuring the task time distribution of nurses in psychiatric care. BMC Nurs 2019; 18:67. [PMID: 31866762 PMCID: PMC6918547 DOI: 10.1186/s12912-019-0386-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/20/2019] [Indexed: 01/29/2023] Open
Abstract
Background The nurse’s primary task in psychiatric care should be to plan for the patient’s care in cooperation with the patient and spend the time needed to build a relationship. Psychiatric care nurses however claim that they lack the necessary time to communicate with patients. To investigate the validity of such claims, this time-motion study aimed at identifying how nurses working at inpatient psychiatric wards distribute their time between a variety of tasks during a working day. Methods During the period of December 2015 and February 2016, a total of 129 h and 23 min of structured observations of 12 nurses were carried out at six inpatient wards at one psychiatric clinic in southern Sweden. Time, frequency of tasks and number of interruptions were recorded and analysed using descriptive statistics. Results Administering drugs or medications accounted for the largest part of the measured time (17.5%) followed by indirect care (16%). Relatively little time was spent on direct care, the third largest category in the study (15.3%), while an unexpectedly high proportion of time (11.3%) was spent on ward related tasks. Nurses were also interrupted in 75% of all medication administering tasks. Conclusions Nurses working in inpatient psychiatric care spend little time in direct contact with the patients and medication administration is interrupted very often. As a result, it is difficult to establish therapeutic relationships with patients. This is an area of concern for both patient safety and nurses’ job satisfaction.
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Affiliation(s)
- Andreas Glantz
- Department of General Psychiatry, Psychiatry & Habilitation, Region Skåne, Vuxenpsykiatrimottagning, Elisetorpsvägen 11 B, 232 33 Arlöv, Sweden.,2Department of Care Science, Faculty of Health and Society, Malmö University, Hälsa och samhälle, Jan Waldenströms gata 25, 214 28 Malmö, Sweden
| | - Karin Örmon
- 2Department of Care Science, Faculty of Health and Society, Malmö University, Hälsa och samhälle, Jan Waldenströms gata 25, 214 28 Malmö, Sweden
| | - Boel Sandström
- 3Department of Health, Faculty of Engineering, Blekinge Institute of Technology (Blekinge Tekniska Högskola), 371 79 Karlskrona, Sweden
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Härkänen M, Blignaut A, Vehviläinen-Julkunen K. Focus group discussions of registered nurses' perceptions of challenges in the medication administration process. Nurs Health Sci 2018; 20:431-437. [PMID: 29745001 DOI: 10.1111/nhs.12432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
Medication administration (MA) holds a great threat to patient safety, as MA errors remain a global problem. Nurses are key role players in the MA process and can give valuable information from the grassroots level. The aim of the present study was to describe registered nurses' perceptions related to challenges in the MA process. Focus group interviews with registered nurses (n = 20) in two central hospitals in Finland were conducted in 2015. Inductive content analysis was performed. Nurses described multiple challenges during MA, which made the process demanding. These were organized under five themes: (i) medications; (ii) collaboration between health-care professionals; (iii) resources and work environment; (iv) skills and education; and (v) patient-related factors. The MA process is prone to errors, and registered nurses described many challenges related to MA. While nurses are responsible for their various work-related tasks and the maintenance of patient safety through applicable procedures and effective collaboration, health systems and hospital management should be stewards of patient safety by ensuring adequate staffing levels and providing educational resources related to the MA process.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Alwiena Blignaut
- School of Nursing Science, North-West University, Potchefstroom, South Africa
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
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Abstract
For quality measures, confusion and discontentment have increased, as availability of electronic data and data collection tools has expanded. We examined current issues with quality measures across 4 stakeholder groups: developers, regulators/endorsers, data collectors, and consumer advocates. There are missing quality measures, issues with data quality and purpose, questionable usability of electronic health records, and an increased measurement burden and cost. Policymakers, administrators, health care professionals, and consumers need to collaborate on measure development and selection.
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Antinaho T, Kivinen T, Turunen H, Partanen P. Increasing value-adding patient care by applying a modified TCAB program. Leadersh Health Serv (Bradf Engl) 2017; 30:411-427. [PMID: 28893120 DOI: 10.1108/lhs-11-2016-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to evaluate a development process aimed at increasing registered nurses' (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals. Design/methodology/approach Basic data for the development process were collected on RNs' working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs' working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis ( N = 64). Findings RNs' working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs' working time use. Practical implications The development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work. Originality/value Even minor changes in nurses' daily work profile can have considerable effects on RNs' work. The TCAB program was shown to be a useful method in developing RNs' work also in psychiatric units.
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Affiliation(s)
- Tuula Antinaho
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland and Central Finland Health Care District, Jyväskylä, Finland
| | - Tuula Kivinen
- Department of Health and Social Management, University of Eastern Finland , Kuopio, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland
| | - Pirjo Partanen
- Department of Nursing Science, University of Eastern Finland , Kuopio, Finland
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Palese A, Basso F, Del Negro E, Achil I, Ferraresi A, Morandini M, Moreale R, Mansutti I. When are night shifts effective for nursing student clinical learning? Findings from a mixed-method study design. NURSE EDUCATION TODAY 2017; 52:15-21. [PMID: 28214665 DOI: 10.1016/j.nedt.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/15/2017] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. OBJECTIVES The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. DESIGN An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. SETTING Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. PARTICIPANTS First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. METHODS First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. RESULTS Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p=0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a "time potentially capable of generating clinical learning": learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. CONCLUSIONS Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks.
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Affiliation(s)
- Alvisa Palese
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Felix Basso
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Elena Del Negro
- Department of Surgery, San Daniele del Friuli Hospital, Italy.
| | - Illarj Achil
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Annamaria Ferraresi
- U.O. Formazione e Aggiornamento, Azienda Ospedaliero-Universitaria (AOU), Ferrara, Italy.
| | - Marzia Morandini
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Renzo Moreale
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Irene Mansutti
- Department of Medical and Biological Sciences, University of Udine, Italy.
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Michel L, Waelli M, Allen D, Minvielle E. The content and meaning of administrative work: a qualitative study of nursing practices. J Adv Nurs 2017; 73:2179-2190. [PMID: 28276090 DOI: 10.1111/jan.13294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM To investigate the content and meaning of nurses' administrative work. BACKGROUND Nurses often report that administrative work keeps them away from bedside care. The content and meaning of this work remains insufficiently explored. DESIGN Comparative case studies. METHOD The investigation took place in 2014. It was based on 254 hours of observations and 27 interviews with nurses and staff in two contrasting units: intensive care and long-term care. A time and motion study was also performed over a period of 96 hours. RESULTS Documentation and Organizational Activities is composed of six categories; documenting the patient record, coordination, management of patient flow, transmission of information, reporting quality indicators, ordering supplies- stock management Equal amounts of time were spent on these activities in each case. Nurses did not express complaints about documentation in intensive care, whereas they reported feeling frustrated by it in long-term care. These differences reflected the extent to which these activities could be integrated into nurses' clinical work and this is in turn was related to several factors: staff ratios, informatics, and relevance to nursing work. CONCLUSION Documentation and Organizational Activities are a main component of care. The meaning nurses attribute to them is dependent on organizational context. These activities are often perceived as competing with bedside care, but this does not have to be the case. The challenge for managers is to fully integrate them into nursing practice. Results also suggest that nurses' Documentation and Organizational Activities should be incorporated into informatics strategies.
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Affiliation(s)
- Lucie Michel
- MOS Research Unit, EHESP, French School of Public Health, Institut Gusave-Roussy, France.,ANFH- French National Association for Health Workers' Continuing Professional Development, Paris, France
| | - Mathias Waelli
- MOS Research Unit, EHESP, French School of Public Health, Institut Gusave-Roussy, France
| | - Davina Allen
- Cardiff School of Nursing and Midwifery Studies, Cardiff University, UK
| | - Etienne Minvielle
- MOS Research Unit, EHESP, French School of Public Health, Institut Gusave-Roussy, France
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Antinaho T, Kivinen T, Turunen H, Partanen P. Improving the quality of registered nurses’ working time use data. J Clin Nurs 2017; 26:3031-3043. [DOI: 10.1111/jocn.13650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Tuula Antinaho
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Central Finland Health Care District; Jyväskylä Finland
| | - Tuula Kivinen
- Department of Health and Social Management; University of Eastern Finland; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
| | - Pirjo Partanen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
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Roche MA, Friedman S, Duffield C, Twigg DE, Cook R. A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study. J Adv Nurs 2016; 73:1421-1432. [DOI: 10.1111/jan.13224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael A. Roche
- School of Nursing Midwifery and Paramedicine Australian Catholic University and Northern Sydney Local Health District New South Wales Australia
- Faculty of Health University of Technology Sydney New South Wales Australia
| | - Sarah Friedman
- Faculty of Health University of Technology Sydney New South Wales Australia
| | - Christine Duffield
- Faculty of Health University of Technology Sydney New South Wales Australia
- Edith Cowan University Joondalup Western Australia Australia
| | - Diane E. Twigg
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
- Centre for Nursing Research Sir Charles Gairdner Hospital Nedlands Western Australia Australia
| | - Rebecca Cook
- Faculty of Health University of Technology Sydney New South Wales Australia
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Lavander P, Meriläinen M, Turkki L. Working time use and division of labour among nurses and health-care workers in hospitals - a systematic review. J Nurs Manag 2016; 24:1027-1040. [DOI: 10.1111/jonm.12423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Päivi Lavander
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Merja Meriläinen
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Leena Turkki
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
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Bjerregård Madsen J, Kaila A, Vehviläinen-Julkunen K, Miettinen M. Time allocation and temporal focus in nursing management: an integrative review. J Nurs Manag 2016; 24:983-993. [PMID: 27411357 DOI: 10.1111/jonm.12411] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe the time allocation and temporal focus in nursing management. BACKGROUND There is limited information about the time allocation and temporal focus of nursing management activities. The role of nurse administrators is changing, resulting in challenges related to time management. METHODS Published literature in 2005-2014 related to the time allocation or temporal focus of nurse administrators' management activities was retrieved from five databases, and an integrative review was conducted. Data extraction, quality assessment and quantitative content analysis were performed for eight reviewed articles. RESULTS Daily reactive management activities and administrative routines were dominant in the nurse administrators' work, and strategic, proactive activities were scarce. Their daily work was fragmented by a variety of activities and numerous interruptions. CONCLUSION Little information exists about time allocation or temporal focus in nurse administrators' management activities. Further research on this topic is needed. The evidence was fairly modest, although the studies' results were generally similar. IMPLICATIONS FOR NURSING MANAGEMENT These results can be used to clarify the job descriptions of nurse administrators and to plan and focus their education and training. Organisations need to use evidence to standardise the job descriptions of different levels of nurse managers and directors.
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Affiliation(s)
| | - Arja Kaila
- Nursing Development, North Karelia Central Hospital and Honkalampi Centre, Joensuu, Finland
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Tenkanen H, Taskinen H, Kontio R, Repo-Tiihonen E, Tiihonen J, Kinnunen J. Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia. JOURNAL OF FORENSIC NURSING 2016; 12:64-73. [PMID: 27195927 DOI: 10.1097/jfn.0000000000000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.
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Affiliation(s)
- Helena Tenkanen
- Author Affiliations: 1Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital; 2Department of Health and Social Management, University of Eastern Finland; 3Department of Psychiatry, University of Helsinki and Helsinki University Hospital; 4Department of Clinical Neuroscience, Karolinska Institutet; 5Central Finland Health Care District
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Qian S, Yu P, Hailey DM, Wang N. Factors influencing nursing time spent on administration of medication in an Australian residential aged care home. J Nurs Manag 2015; 24:427-34. [DOI: 10.1111/jonm.12343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Siyu Qian
- School of Computing and Information Technology; University of Wollongong; New South Wales 2522 Australia
| | - Ping Yu
- School of Computing and Information Technology; University of Wollongong; New South Wales 2522 Australia
| | - David M. Hailey
- School of Computing and Information Technology; University of Wollongong; New South Wales 2522 Australia
| | - Ning Wang
- Regis Aged Care Bayside Garden Australia
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