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Conti A, Gonella S, Berardinelli D, Dimonte V, Campagna S. Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study. J Adv Nurs 2024. [PMID: 38967383 DOI: 10.1111/jan.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
AIM To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. DESIGN Mixed-methods explanatory sequential. METHODS In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. RESULTS Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. CONCLUSION Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. IMPACT This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. REPORTING METHODS MMR checklist. PATIENT/PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
- Department of Nursing and Allied Health Professions, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
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Sezgin E, Sirrianni JW, Kranz K. Evaluation of a Digital Scribe: Conversation Summarization for Emergency Department Consultation Calls. Appl Clin Inform 2024; 15:600-611. [PMID: 38749477 PMCID: PMC11268986 DOI: 10.1055/a-2327-4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/14/2024] [Indexed: 07/26/2024] Open
Abstract
OBJECTIVE We present a proof-of-concept digital scribe system as an Emergency Department (ED) consultation call-based clinical conversation summarization pipeline to support clinical documentation, and report its performance. MATERIALS AND METHODS We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among ED clinicians and medical records. We report the ROUGE-1, ROUGE-2, and ROUGE-L to compare model performance. In addition, we annotated transcriptions to assess the quality of generated summaries. RESULTS The fine-tuned BART-Large-CNN model demonstrates greater performance in summarization tasks with the highest ROUGE scores (F1ROUGE-1=0.49, F1ROUGE-2=0.23, F1ROUGE-L=0.35) scores. In contrast, PEGASUS-PubMed lags notably (F1ROUGE-1=0.28, F1ROUGE-2=0.11, F1ROUGE-L=0.22). BART-Large-CNN's performance decreases by more than 50% with the zero-shot approach. Annotations show that BART-Large-CNN performs 71.4% recall in identifying key information and a 67.7% accuracy rate. DISCUSSION The BART-Large-CNN model demonstrates a high level of understanding of clinical dialogue structure, indicated by its performance with and without fine-tuning. Despite some instances of high recall, there is variability in the model's performance, particularly in achieving consistent correctness, suggesting room for refinement. The model's recall ability varies across different information categories. CONCLUSION The study provides evidence towards the potential of AI-assisted tools in assisting clinical documentation. Future work is suggested on expanding the research scope with additional language models and hybrid approaches, and comparative analysis to measure documentation burden and human factors.
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Affiliation(s)
- Emre Sezgin
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
- The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Joseph W. Sirrianni
- IT Research and Innovation, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Kelly Kranz
- Physician Consult and Transfer Center, Nationwide Children's Hospital, Columbus, Ohio, United States
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Koppitz A, Spichiger F, Keller-Senn A, Bana M, Huber C, Christi D, Bucher T, Volken T. Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey. J Adv Nurs 2024. [PMID: 38712897 DOI: 10.1111/jan.16211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
AIM To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation. DESIGN A secondary explorative analysis of a cross-sectional survey. METHODS The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates. RESULTS The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'. CONCLUSION The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay. IMPACT Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention. REPORTING METHOD This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist. PATIENT OR PUBLIC CONTRIBUTION There were no patient or public contributions. TRIAL AND PROTOCOL REGISTRATION This study has not been registered.
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Affiliation(s)
- Andrea Koppitz
- School of Health Sciences Fribourg, HES-SO - University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
| | - Frank Spichiger
- School of Health Sciences Fribourg, HES-SO - University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
- Institute of Nursing, Faculty of Biology and Medicine, UNIL - University of Lausanne, Lausanne, Switzerland
| | | | - Marika Bana
- School of Health Sciences Fribourg, HES-SO - University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
| | - Claudia Huber
- School of Health Sciences Fribourg, HES-SO - University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
| | - Derek Christi
- School of Health Sciences Fribourg, HES-SO - University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
| | - Thomas Bucher
- Institute of Health Science, ZHAW - Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Thomas Volken
- Institute of Health Science, ZHAW - Zurich University of Applied Sciences, Winterthur, Switzerland
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4
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Cooper AL, Albrecht MA, Kelly S, Eccles SP, Brown JA. A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives. J Adv Nurs 2024; 80:1452-1463. [PMID: 37983743 DOI: 10.1111/jan.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.
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Affiliation(s)
- Alannah L Cooper
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Matthew A Albrecht
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Kelly
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Siobhan P Eccles
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice, Curtin University, Perth, Western Australia, Australia
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5
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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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Turcato G, Zaboli A, Brigo F, Parodi M, Fulghesu F, Bertorelle L, Sibilio S, Mian M, Ferretto P, Milazzo D, Trentin M, Marchetti M. Real requirements of nursing activities and patient-related factors related to nursing overload in an internal medicine department. Intern Emerg Med 2024; 19:429-443. [PMID: 38093084 DOI: 10.1007/s11739-023-03499-y] [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: 09/02/2023] [Accepted: 11/27/2023] [Indexed: 03/21/2024]
Abstract
Adequate nursing care can be decisive for the outcome of a patient admitted to an internal medicine ward. Individual prediction of nursing activity at the time of a patient's admission could improve the work process. This study aimed to assess the objectively assessed nursing requirements of patients admitted to a medical setting and to identify clinical factors that correlate with high demands. This is a prospective and pragmatic observational study that enrolled patients admitted to the Internal Medicine ward at the Altovicentino Civil Hospital (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first 3 days of hospitalization and standardized as performance/5 min/patient. Patients requiring more than the 75th percentile of performance/5 min/patient were considered nursing over-activities. Multivariable models were used to assess patient-related risk factors associated with nursing over-activity. This study enrolled 333 patients (mean age: 74.2; 55.6% male). Their mean Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), Chronic Barthel Index, and Sistema Informtativo della Performance Infermieristica (SIPI) scores were 5.3, 4.2, 62.4, and 53.7, respectively. Mean National Early Warning System (NEWS) on admission was 3.9 (standard deviation: 2.8). A median of 73 (interquartile range [IQR]: 54-109) nursing care activities/5 min/patient were performed. NEWS score (odds ratio [OR]: 1.372, 95% confidence interval [95%CI]: 1.216-1.547, p < 0.001) and Acute Barthel Index (OR: 0.983, 95%CI: 0.967-0.999, p = 0.041) were independent risk factors for nursing over-activities. NEWS and the Acute Barthel Index could help reorganize nursing resources within internal medicine wards, allowing for an equal distribution between patients who require more resources and those who require less.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, 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), via Garziere, 43, 36014, Santorso, Italy
| | - Francesca Fulghesu
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Lidia Bertorelle
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - 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), via Garziere, 43, 36014, Santorso, Italy
| | - Daniela Milazzo
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Monica Trentin
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Massimo Marchetti
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
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Mahran GSK, Mekkawy MM, Ibrahim BA, Saber EA, Ali M, Abbas MS, Mohamed SAA, Ahmed RD. Designing and Validating an Evidence-Based, Shift-to-Shift Handover Bundle for Nurses and Physicians. Crit Care Nurs Q 2024; 47:41-50. [PMID: 38031307 DOI: 10.1097/cnq.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This article reports a study aimed at developing and validating an evidence-based, shift-to-shift handover bundle for nurses and physicians to be used at shift changes in intensive care and emergency units. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability can have unwanted consequences for hospitalized patients, particularly those at critical areas. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, standardized handover bundles for nurses and physicians are limited in the emergency and intensive care unit. As a result of this study, a shift-to-shift handover bundle was created, which was an evidence-based research design. This bundle is expected to be helpful for proper patient transfers between these critical areas, ensuring patient safety and efficient quality management.
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Affiliation(s)
- Ghada Shalaby Khalaf Mahran
- Departments of Critical Care and Emergency Nursing (Drs Mahran and Ali) and Nursing Administration (Dr Saber), Faculty of Nursing, Assiut University, Assiut, Egypt; Department of Medical Surgical Nursing, Al-Galala University, Suez, Egypt (Dr Mekkawy); Department of Medical Surgical Nursing, Minia University, Minia, Egypt (Dr Ibrahim); Departments of Anesthesia and Intensive Care (Dr Abbas) and Chest Diseases and Tuberculosis (Dr Mohamed), Faculty of Medicine, Assiut University, Assiut, Egypt; Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia (Dr Mohamed); and Department of Critical Care and Emergency Nursing, Faculty of Nursing, South Valley University, Qena, Egypt (Dr Ahmed)
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Routly M, Gettis M. A Quality Improvement Project to Revise and Reduce Nursing Data Entry in a Pediatric Trauma Unit. J Nurs Adm 2024; 54:E1-E4. [PMID: 38117155 DOI: 10.1097/nna.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Meaningful direct nurse-patient interactions have been found to positively influence patient experiences and outcomes while increasing nurse satisfaction. Through redesigning a database, this process improvement project reduced nurse data entry time, allowing more opportunities for direct patient interactions. This project demonstrated that database redesign is a strategic action to decrease nurse data entry workload that can be used in hospital settings.
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Affiliation(s)
- Maia Routly
- Author Affiliations: Program Manager of the Strong4Life Clinic and Bariatric Program (Dr Routly), Children's Healthcare of Atlanta, Center for Advanced Pediatrics; and Nurse Scientist/Pediatric Nurse Practitioner (Dr Gettis), Children's Healthcare of Atlanta - Scottish Rite Campus, Georgia
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9
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Sezgin E, Sirrianni J, Kranz K. Development and Evaluation of a Digital Scribe: Conversation Summarization Pipeline for Emergency Department Counseling Sessions towards Reducing Documentation Burden. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.06.23299573. [PMID: 38106162 PMCID: PMC10723557 DOI: 10.1101/2023.12.06.23299573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective We present a proof-of-concept digital scribe system as an ED clinical conversation summarization pipeline and report its performance. Materials and Methods We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among ED clinicians and medical records. We report the ROUGE-1, ROUGE-2, and ROUGE-L to compare model performance. In addition, we annotated transcriptions to assess the quality of generated summaries. Results The fine-tuned BART-Large-CNN model demonstrates greater performance in summarization tasks with the highest ROUGE scores (F1ROUGE-1=0.49, F1ROUGE-2=0.23, F1ROUGE-L=0.35) scores. In contrast, PEGASUS-PubMed lags notably (F1ROUGE-1=0.28, F1ROUGE-2=0.11, F1ROUGE-L=0.22). BART-Large-CNN's performance decreases by more than 50% with the zero-shot approach. Annotations show that BART-Large-CNN performs 71.4% recall in identifying key information and a 67.7% accuracy rate. Discussion The BART-Large-CNN model demonstrates a high level of understanding of clinical dialogue structure, indicated by its performance with and without fine-tuning. Despite some instances of high recall, there is variability in the model's performance, particularly in achieving consistent correctness, suggesting room for refinement. The model's recall ability varies across different information categories. Conclusion The study provides evidence towards the potential of AI-assisted tools in reducing clinical documentation burden. Future work is suggested on expanding the research scope with larger language models, and comparative analysis to measure documentation efforts and time.
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Affiliation(s)
- Emre Sezgin
- Nationwide Children's Hospital, Columbus OH
- Ohio State University College of Medicine, Columbus OH
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10
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amer A. Alzahrani
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Ensherah Saeed Althobiti
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Berwick, VIC 3806, Australia;
| | - Afnan Z. Sahrah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Maha Jabar Alkhaldi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Eishah Fahad Rajab
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Amani R. Alsalmi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Merhamah E. Abdullah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | | | - Mari-zel M. Caslangen
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Mariam G. Ismail
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Talal Awadh Alqurashi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
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12
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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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13
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Xie J, Wu X, Li J, Li X, Xiao P, Wang S, Zhong Z, Ding S, Yan J, Li L, Cheng ASK. Time management disposition and relevant factors among new nurses in Chinese tertiary hospitals: A cross-sectional study. Front Psychol 2022; 13:956945. [PMID: 36051191 PMCID: PMC9426297 DOI: 10.3389/fpsyg.2022.956945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction New nurses struggled with time management, which was a prominent theme in safety care for patients. However, the transition training of time management for new nurses was complicated and ignored by clinical managers. The purpose of this study was to understand the level of new nurses’ TMD from a nationwide perspective and detect the influencing factors of the TMD. Materials and methods A cross-sectional study design with a stratified sampling method was sampled in China. Six hundred and seventy new nurses within the first year of employment were recruited. New nurses’ time management disposition, job stressors, self-efficacy, clinical communication competence, and safety behavior were measured by corresponding scales. Results New nurses showed the best sense of time’s value, followed by the sense of time efficacy and time monitoring view for time management disposition. The related factors of time management disposition were communication skills, safety behavior, job stressors, and being without a preceptor. New nurses’ time management disposition was at a moderate level and they performed worse in time allocation. The highest education, with or without a preceptor, the experience of part-time jobs, and class cadre were significantly influencing the time management disposition of new nurses. Conclusion Nursing managers should pay attention to new nurses’ time management disposition. Reducing the job stressors, improving communication ability, and safe behavior were important measures to improve the time management disposition.
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Affiliation(s)
- Jianfei Xie
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoqi Wu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jie Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaolian Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Panpan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Sha Wang
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jin Yan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jin Yan,
| | - Lijun Li
- Xiangya School of Nursing, Central South University, Changsha, China
- Lijun Li,
| | - Andy S. K. Cheng
- The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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14
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Abt M, Lequin P, Bobo ML, Vispo Cid Perrottet T, Pasquier J, Ortoleva Bucher C. The scope of nursing practice in a psychiatric unit: A time and motion study. J Psychiatr Ment Health Nurs 2022; 29:297-306. [PMID: 34310817 PMCID: PMC9290684 DOI: 10.1111/jpm.12790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: The evaluation of nurse care practices poses many challenges, including the identification of all the aspects of the care given. Few studies have looked at the scope of nursing practice in psychiatry. However, the evaluation of care practices in the mental health field poses many challenges, including the identification of all aspects of care. WHAT THE DOCUMENT ADDS TO EXISTING KNOWLEDGE?: Findings demonstrated that mental health nurses do not invest in all domains of their scope of practice in the same way and the time spent with patients is low. Several factors contributed to this, including the increasing complexity of care, stagnant staffing levels, and a culture of care that continues to be influenced by the medical model. Current models of care still retain the stigma of this past, prioritizing medically delegated tasks rather than promoting a holistic approach to care. Although the professional identity of nurses is evolving and asserting itself, the paradigm shift in practice is still incomplete. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to describe concretely what is actually expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement. The field of practice of nurses is put under stress by a demanding work environment subject to many pressures and constraints. Changing practices so that nurses can use the full scope of nursing practice requires strong nursing leadership and action on education and the organization of care, particularly on clinical assessment. ABSTRACT: Introduction The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry. Aim The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017, Perspect Infirm Rev Off Ordre Infirm Qué, 14, 51) Scope of Nursing Practice Model. Method This 56-day descriptive observational study used the time and motion method to follow eight nurses. Results 500 h of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education. Discussion Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.
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Affiliation(s)
- Maryline Abt
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Pierre Lequin
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Louise Bobo
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
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15
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Ivziku D, Ferramosca FMP, Filomeno L, Gualandi R, De Maria M, Tartaglini D. Defining nursing workload predictors: A pilot study. J Nurs Manag 2021; 30:473-481. [PMID: 34825432 PMCID: PMC9300160 DOI: 10.1111/jonm.13523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 01/10/2023]
Abstract
Aim To explore predictors of perceived nursing workload in relation to patients, nurses and workflow. Background Nursing workload is important to health care organisations. It determines nurses' well‐being and quality of care. Nevertheless, its predictors are barely studied. Methods A cross‐sectional prospective design based on the complex adaptive systems theory was used. An online survey asked nurses to describe perceived workload at the end of every shift. Data were gathered from five medical‐surgical wards over three consecutive weeks. We received 205 completed surveys and tested multivariate regression models. Results Patient acuity, staffing resources, patient transfers, documentation, patient isolation, unscheduled activities and patient specialties were significant in predicting perceived workload. Nurse‐to‐patient ratio proved not to be a predictor of workload. Conclusions This study significantly contributed to literature by identifying some workload predictors. Complexity of patient care, staffing adequacy and some workflow aspects were prominent in determining the shift workload among nurses. Implications for nursing management Our findings provide valuable information for top and middle hospital management, as well as for policymakers. Identification of predictors and measurement of workload are essential for optimizing staff resources, workflow processes and work environment. Future research should focus on the appraisal of more determinants.
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Affiliation(s)
- Dhurata Ivziku
- Department of Nursing Innovation and Development, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | | | - Lucia Filomeno
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Raffaella Gualandi
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
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16
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Prevedello D, Steckelmacher C, Devroey M, Njimi H, Creteur J, Preiser JC. The burden of implementation: A mixed methods study on barriers to an ICU follow-up program. J Crit Care 2021; 65:170-176. [PMID: 34171692 DOI: 10.1016/j.jcrc.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE It has been suggested that ICU follow-up clinics can offer support for ICU survivors and their relatives. However, implementation of such clinics can be challenging. We explored the barriers to implementation of an ICU follow-up program from the healthcare providers' perspective. METHODS This was a mixed methods study with a triangulation design conducted over the 7-month pilot period of an ICU follow-up program. RESULTS The quantitative analysis showed that two main tasks within the program took the most time to be completed: training and tracking. Training new healthcare professionals to acquire the necessary competences for the follow-up clinic was the most time-consuming task [30 min (IQR 13-56)]. Tracking patients, which consists of keeping records of a patient during the hospital stay and when discharged, was the second most time-consuming task [15 min (IQR 10-20)]. We recorded 291 items of qualitative data from the 12 team members who participated. The qualitative analysis identified three domains that were crucial barriers for program implementation: Luhr et al. (2019) [1] organization (37.1%), Máca et al. (2017) [2] engagement (38.5%), and (Gayat et al., 2018 [3]) resources (24%). In agreement with the quantitative data, training and tracking were perceived by participants as laborious tasks and key barriers to implementation of the ICU follow-up program. Despite the expectation that resources would be the most important barrier, they were not considered as such by our participants being only mentioned in 13.4% of our qualitative reports; when mentioned, this barrier was related mostly to insufficient numbers of staff members. CONCLUSIONS Awareness of those barriers can help healthcare providers and ICU managers in developing strategies adapted to overcome constraints, thus facilitating the implementation process.
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Affiliation(s)
- Danielle Prevedello
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
| | - Claire Steckelmacher
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Marianne Devroey
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
| | - Hassane Njimi
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
| | - Jean-Charles Preiser
- Department of Intensive Care Medicine, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
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17
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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: 20] [Impact Index Per Article: 6.7] [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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18
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Weller-Newton JM, Phillips C, Roche MA, McGillion A, Mapes J, Dufty T, Schlieff J, Boyd L, Geary A, Haines S. Datasets to support workforce planning in nursing: A scoping review. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Nowell L, Dhingra S, Andrews K, Jackson J. A grounded theory of clinical nurses' process of coping during COVID-19. J Clin Nurs 2021:10.1111/jocn.15809. [PMID: 33955629 PMCID: PMC8242450 DOI: 10.1111/jocn.15809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore clinical nurses' process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster. BACKGROUND The COVID-19 pandemic has provoked widespread disruption to clinical nurses' work. It is important to understand clinical nurses' processes of coping during disasters to support the nursing workforce during events such as global pandemics. DESIGN We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses' coping processes inductively building concepts around these points. RESULTS The predictor of nurses' outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID-a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses' confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing. CONCLUSIONS Understanding clinical nurses' experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters. RELEVANCE TO CLINICAL PRACTICE Nurse leaders can target areas that support nurses' confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.
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Affiliation(s)
| | - Swati Dhingra
- Faculty of NursingUniversity of CalgaryCalgaryABCanada
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20
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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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21
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Moy AJ, Schwartz JM, Chen R, Sadri S, Lucas E, Cato KD, Rossetti SC. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. J Am Med Inform Assoc 2021; 28:998-1008. [PMID: 33434273 PMCID: PMC8068426 DOI: 10.1093/jamia/ocaa325] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND . OBJECTIVE Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout. While clear classifications and validated measures of burnout exist, documentation burden remains ill-defined and inconsistently measured. We aim to conduct a scoping review focused on identifying approaches to documentation burden measurement and their characteristics. MATERIALS AND METHODS Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews (ScR) guidelines, we conducted a scoping review assessing MEDLINE, Embase, Web of Science, and CINAHL from inception to April 2020 for studies investigating documentation burden among physicians and nurses in ambulatory or inpatient settings. Two reviewers evaluated each potentially relevant study for inclusion/exclusion criteria. RESULTS Of the 3482 articles retrieved, 35 studies met inclusion criteria. We identified 15 measurement characteristics, including 7 effort constructs: EHR usage and workload, clinical documentation/review, EHR work after hours and remotely, administrative tasks, cognitively cumbersome work, fragmentation of workflow, and patient interaction. We uncovered 4 time constructs: average time, proportion of time, timeliness of completion, activity rate, and 11 units of analysis. Only 45.0% of studies assessed the impact of EHRs on clinicians and/or patients and 40.0% mentioned clinician burnout. DISCUSSION Standard and validated measures of documentation burden are lacking. While time and effort were the core concepts measured, there appears to be no consensus on the best approach nor degree of rigor to study documentation burden. CONCLUSION Further research is needed to reliably operationalize the concept of documentation burden, explore best practices for measurement, and standardize its use.
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Affiliation(s)
- Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | | | - RuiJun Chen
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Department of Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania, USA
| | - Shirin Sadri
- Vagelos School of Physicians and Surgeons, Columbia University New York, New York, USA
| | - Eugene Lucas
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Kenrick D Cato
- School of Nursing, Columbia University, New York, New York, USA
| | - Sarah Collins Rossetti
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- School of Nursing, Columbia University, New York, New York, USA
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Jackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud 2021; 122:103944. [PMID: 34325358 DOI: 10.1016/j.ijnurstu.2021.103944] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is ample evidence that modern nurses are under strain and that interventions to support the nursing workforce have not recognised the complexity inherent in nursing work. Creating a modern model of nursing work may assist nurses in developing workable solutions to professional problems. A new model may also foster cohesion among broad and diverse nursing roles. AIM The aim of this meta-narrative review was to investigate how researchers, using different methods and theoretical approaches, have contributed to the understanding of nursing work. METHODS A meta-narrative review was done to evaluate the trajectory of nursing work research, from 1953 to present. This review progressed through the stages of planning, searching, mapping, appraisal, and synthesis. FINDINGS A total of 121 articles were included in this meta-narrative review. These articles revealed five narratives of nursing work, where work is conceptualised as labour. These narratives were physical labour (n = 14), emotional (n = 53), cognitive (n = 24), and organisational (n = 1), and combinations of more than one type of labour (n = 29 articles). The paradigms identified in the meta-narrative were the positivist, interpretive, critical, and evidence-based paradigms. Each article in the review corresponded with a paradigm and a labour narrative, creating a comprehensive model. CONCLUSIONS Nursing work can be understood as a model of physical, emotional, cognitive, and organisational labour. These different types of labour may be hidden and taken for granted. Nurses can use this model to articulate what they do and how it supports patient safety. Nurses can also advocate for staffing allocations that consider all types of nursing labour. Tweetable abstract Nursing work is complex and includes physical, emotional, cognitive, and organisational labour. Staffing needs to take all nursing labour into account.
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Affiliation(s)
- Jennifer Jackson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK.
| | - Janet E Anderson
- Professor of Quality of Care for Older People, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH UK.
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23
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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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24
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Moore EC, Tolley CL, Bates DW, Slight SP. A systematic review of the impact of health information technology on nurses' time. J Am Med Inform Assoc 2021; 27:798-807. [PMID: 32159770 PMCID: PMC7309250 DOI: 10.1093/jamia/ocz231] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Nursing time represents one of the highest costs for most health services. We conducted a systematic review of the literature on the impact of health information technology on nurses' time. MATERIALS AND METHODS We followed PRISMA guidelines and searched 6 large databases for relevant articles published between Jan 2004 and December 2019. Two authors reviewed the titles, abstracts, and full texts. We included articles that included a comparison group in the design, measured the time taken to carry out documentation or medication administration, documented the quantitative estimates of time differences between the 2, had nurses as subjects, and was conducted in either a care home, hospital, or community clinic. RESULTS We identified a total of 1647 articles, of which 33 met our inclusion criteria. Twenty-one studies reported the impact of 12 different health information technology (HIT) implementations on nurses' documentation time. Weighted averages were calculated for studies that implemented barcode medication administration (BCMA) and 2 weighted averages for those that implemented EHRs, as these studies used different sampling units; both showed an increase in the time spent in documentation (+22% and +46%). However, the time spent carrying out medication administration following BCMA implementation fell by 33% (P < .05). HIT also caused a redistribution of nurses' time which, in some cases, was spent in more "value-adding" activities, such as delivering direct patient care as well as inter-professional communication. DISCUSSION AND CONCLUSIONS Most of the HIT systems increased nursing documentation time, although time fell for medication administration following BCMA. Many HIT systems also resulted in nurses spending more time in direct care and "value-adding" activities.
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Affiliation(s)
- Esther C Moore
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Clare L Tolley
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Corresponding Author: Clare L. Tolley, PhD, MPharm, FHEA, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK ()
| | - David W Bates
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Partners HealthCare, Somerville, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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25
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Freysteinson WM, Celia T, Gilroy H, Gonzalez K. The experience of nursing leadership in a crisis: A hermeneutic phenomenological study. J Nurs Manag 2021; 29:1535-1543. [PMID: 33742517 DOI: 10.1111/jonm.13310] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/28/2023]
Abstract
AIM This study aimed to understand nursing leaders' experience during the pandemic. BACKGROUND COVID-19 is a public health crisis that affects every nation in the world. METHODS Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology. RESULTS The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future. CONCLUSION Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications. IMPLICATIONS FOR NURSING MANAGEMENT In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.
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Affiliation(s)
| | - Tania Celia
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX, USA
| | - Heidi Gilroy
- Memorial Hermann The Woodlands Medical Center, Houston, TX, USA
| | - Kimberly Gonzalez
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX, USA
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26
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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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27
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Kriegel J, Rissbacher C, Reckwitz L, Tuttle-Weidinger L. The requirements and applications of autonomous mobile robotics (AMR) in hospitals from the perspective of nursing officers. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1870353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Johannes Kriegel
- Institute for Management and Economics in Healthcare, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall i.T., Austria
| | - Clemens Rissbacher
- Head of Institute of Integrated Healthcare, tirol kliniken, Innsbruck, Austria
| | - Luise Reckwitz
- Department of Automation and Computer Sciences, Harz University of Applied Sciences, Wernigerode, Germany
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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28
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Abstract
OBJECTIVE The aim of this study was to assess the differences in patient complications as well as patient and staff satisfaction between a mixed-skill unit and an all-registered nurse (RN) unit. BACKGROUND It is recognized that nursing care delivered by RNs results in better outcomes; however, more evidence is needed to support a change to an all-RN unit. METHODS A mixed unit with RNs and unlicensed assistive personnel was compared with an all-RN unit. Each unit had similar resources. Patient complications and patient and staff satisfaction were measured. Patient complications were reported in terms of 1,000 patient days over the study period to minimize noise fluctuations; t test and χ compared means and frequencies, respectively. RESULTS The all-RN unit had a lower prevalence of patient complications. Patients reported better pain management, and nurse explanation, and reported higher satisfaction on the all-RN unit. CONCLUSIONS An all-RN unit provided superior outcomes compared with a mixed-skill unit without additional costs.
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29
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Peršolja M. The quality of nursing care as perceived by nursing personnel: Critical incident technique. J Nurs Manag 2020; 29:432-441. [PMID: 33051916 DOI: 10.1111/jonm.13180] [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: 07/17/2020] [Revised: 09/26/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To identify the determinants of the quality of nursing care from the perceptions of nursing personnel. BACKGROUND The quality of nursing care is often measured with standards, expectations, satisfaction and outcomes, but in developing countries, it relies mostly on negative indicators. METHODS A descriptive qualitative study was used. Semi-structured interviews based on the critical incident technique were conducted with a convenience sample of 136 nursing personnel who told 225 stories. RESULTS Seven quality determinants of nursing care were identified as follows: standard of care, triage and assessment, emergency care, communication with the patient or family, communication with colleagues, multidisciplinary teamwork and helping colleagues. The most important one was the standard of care. CONCLUSION Quality nursing care is based on the degree of excellence nursing personnel show with regard to their competences in technical care, communication and teamwork. A key attribute of quality nursing care is defined by the related standards, and the focus is mostly on the nursing care process. IMPLICATIONS FOR NURSING MANAGEMENT These findings can increase awareness of the determinants of nursing quality and the qualities of the nursing personnel involved and can help managers to evaluate nursing practice, select new employees and organise teams.
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Affiliation(s)
- Melita Peršolja
- Faculty of Health Sciences, University of Primorska, Nova Gorica, Slovenia
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30
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Chen W, Chen J, Hu J, Zhao J, Zhang J, He G, Gifford W. The professional activities of nurse managers in Chinese hospitals: A cross-sectional survey in hunan province. J Nurs Manag 2020; 29:143-151. [PMID: 32715553 DOI: 10.1111/jonm.13110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore nurse managers' perceptions of the frequency and importance of professional activities performed in their daily work in public hospitals in Hunan, China. BACKGROUND Nurse managers are responsible for the management of almost all nursing activities in Chinese hospitals. Understanding how nurse managers operationalize their role and their perceptions of the importance of each activity is essential for clarification of their role and the competencies required to perform it. METHODS A cross-sectional questionnaire survey. RESULTS A total of 1,371 nurse managers in Hunan Province completed the survey. Nursing quality/safety management and patient management were performed most frequently and perceived as most important. Nurse managers performed nursing information management frequently while perceiving it as less important. They seldom performed nursing research management and placed low value on it. CONCLUSIONS Patient-centred care remains central to nursing management. Nursing managers can create a leadership culture in their hospital settings that includes the effective management of information and facilitation of research knowledge to benefit nurse managers, staff and patients. IMPLICATIONS FOR NURSING MANAGEMENT The results provide evidence for standardization of roles and job descriptions of nurse managers and for developing their knowledge and skills to ensure quality patient care.
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Affiliation(s)
- Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Xiangya Nursing School, Central South University, Changsha, China.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Jia Chen
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, VA, USA
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Junjun Zhang
- Human Health Resources Development Center, National Health Commission of China, Beijing, China
| | - Guoping He
- Xiangya Nursing School, Central South University, Changsha, China
| | - Wendy Gifford
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
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31
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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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32
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Lim ML, Ang SY. A time–motion observation study to measure and analyse clinical nursing workload in an acute care hospital in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819834569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Internationally, there are concerns about rising nursing workforce shortages, which could be attributed to both recruitment and retention issues. As the population rapidly ages in Singapore, there is an increase in demand for more trained nurses to staff new facilities. Given the problem that Singapore is facing, there is a need for other solutions besides increasing recruitment rate. A time-motion study of nurses’ workload can assist us in determining how and what nurses spend their time on during their working shift. Work processes can then be studied to allow for improvements and implementation of strategies to ease nurses’ workload. Results of the current study demonstrated four main processes (preparing and clearing requisites, documentation, care coordination, transportation) that can be improved upon. Some of these processes do not require dedicated nursing skills; and can potentially be performed for other staff members. Results also demonstrated that nurses spent significantly less time on patient care activities as compared to nurses in United States; with as much as 31% of the nurses’ time being spent on documentation. Future studies can target on the effectiveness of strategies to improve the efficiency and quality of nursing care.
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Affiliation(s)
- Mei Ling Lim
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore
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33
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Malfait S, Van Hecke A, Van Biesen W, Eeckloo K. Do Bedside Handovers Reduce Handover Duration? An Observational Study With Implications for Evidence‐Based Practice. Worldviews Evid Based Nurs 2018; 15:432-439. [DOI: 10.1111/wvn.12330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Simon Malfait
- Ghent University Hospital Belgium
- Faculty of Medicine and Health SciencesDepartment of Public HealthUniversity Center for Nursing and MidwiferyGhent University Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health SciencesDepartment of Public HealthUniversity Center for Nursing and MidwiferyGhent University Belgium
- Staff member Nursing DepartmentGhent University Hospital Belgium
| | - Wim Van Biesen
- Faculty of Medicine and Health SciencesDepartment of Internal MedicineGhent University Belgium
- Head of the Renal DepartmentChair of European Renal Best PracticeGhent University Hospital Belgium
| | - Kristof Eeckloo
- Faculty of Medicine and Health SciencesDepartment of Public HealthGhent University Belgium
- Head of Strategic Policy CellGhent University Hospital Belgium
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34
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Peršolja M. The effect of nurse staffing patterns on patient satisfaction and needs: a cross-sectional study. J Nurs Manag 2018; 26:858-865. [DOI: 10.1111/jonm.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Melita Peršolja
- Nova Gorica Unit of Faculty of Health Sciences; University of Primorska; Nova Gorica Slovenia
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35
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Olivares Bøgeskov B, Grimshaw-Aagaard SLS. Essential task or meaningless burden? Nurses’ perceptions of the value of documentation. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518773906] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given the substantial increase in the documentation required of nurses in recent years, this article explores nurses’ perceptions of the value of documentation, and, subsequently, attempts to explain a puzzling tendency, whereby some nurses attach little value to arguably useful forms of documentation. We use data gathered from individual interviews with nursing leaders and focus-group interviews with frontline nurses at two wards in a Danish hospital. Our thematic analysis shows that nurses are divided between a positive view of documentation as something essential, and a negative one of it being a meaningless burden that distracts nurses from their ‘real’ work, contradicts their professional identity, and does not benefit the patient. However, except for some cases where the same information is registered twice (‘double registration’), we find no objective criteria for determining which types of documentation are perceived positively or negatively, as even arguably useful types are sometimes considered meaningless. We interpret this as being because of conflicting concepts of value: utility vs meaning. Using an existential theory of meaning, we argue that documentation’s practical utility alone is not sufficient to provide meaning. We thus suggest the need for finding a balance between: a) adjusting documentation requirements, b) adapting the nursing profession, and c) changing nurses’ perceptions of the value of documentation.
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36
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Goldman J, MacMillan K, Kitto S, Wu R, Silver I, Reeves S. Bedside nurses' roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued? Nurs Inq 2018; 25:e12236. [PMID: 29607602 DOI: 10.1111/nin.12236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.
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Affiliation(s)
- Joanne Goldman
- Faculty of Medicine, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Simon Kitto
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert Wu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ivan Silver
- Department of Psychiatry, Faculty of Medicine, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Scott Reeves
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK
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37
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Falesse S, Barat P, Castelli C, Antoine V, Chkair S, Bouvet S, Pouysségur V. [Nutritional status of residents of a nursing home and optimisation of the working time of caregivers]. SOINS. GERONTOLOGIE 2018; 23:23-28. [PMID: 29335137 DOI: 10.1016/j.sger.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The lack of time to devote to care is a frequent complaint of nurses and nursing assistants. The results of a study show that an improvement in the nutritional status of nursing home residents could help to improve their quality of life and to optimise the working time of the nursing teams, thanks to the reduction of pressure ulcers, diarrhoea, falls, fractures and infections.
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Affiliation(s)
- Suzanne Falesse
- Résidence Tiers Temps, 29 avenue Dolce Farniente, 06110, Le Cannet, France
| | - Philippe Barat
- Résidence Tiers Temps, 29 avenue Dolce Farniente, 06110, Le Cannet, France
| | - Christel Castelli
- Département de Santé Publique, CHU de Nîmes, Place du Professeur Robert Debré, 30029, Nîmes, France; Laboratoire EA2415, Institut Universitaire de Recherche Clinique, Université de Montpellier, 163 rue Auguste Broussonet, 34000, Montpellier, France
| | - Valéry Antoine
- Pôle Gériatrie, CHU de Nîmes, Place du Professeur Robert Debré, 30029, Nîmes, France
| | - Sihame Chkair
- Département de Santé Publique, CHU de Nîmes, Place du Professeur Robert Debré, 30029, Nîmes, France; Laboratoire EA2415, Institut Universitaire de Recherche Clinique, Université de Montpellier, 163 rue Auguste Broussonet, 34000, Montpellier, France
| | - Sophie Bouvet
- Département de Santé Publique, CHU de Nîmes, Place du Professeur Robert Debré, 30029, Nîmes, France; Laboratoire EA2415, Institut Universitaire de Recherche Clinique, Université de Montpellier, 163 rue Auguste Broussonet, 34000, Montpellier, France
| | - Valérie Pouysségur
- Pôle Odontologie, CHU de Nice, 4 rue Pierre Dévoluy, 06000, Nice, France; Laboratoire Micoralis EA7354, UFR Odontologie, Université Côte d'Azur, 24 avenue des Diables Bleus, 06300, Nice, France.
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